- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,549.93 / $27,542.29
| Facility | | $1,995.26 | $9,549.93 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $24,547.09 / $47,863.01
| Facility | | $18,620.87 | $24,547.09 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,657.95 / $42,657.95 / $42,657.95
| Facility | | $42,657.95 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $11,220.18 / $30,199.52
| Facility | | $1,288.25 | $11,220.18 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,187.76 / $2,754.23
| Professional | | $2,089.30 | $2,187.76 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $23,442.29 / $39,810.72
| Facility | | $10,232.93 | $23,442.29 | $39,810.72 |