- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $12,302.69 / $25,118.86
| Facility | | $3,388.44 | $12,302.69 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $776.25 / $10,232.93
| Professional | | $676.08 | $776.25 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $42,657.95 / $48,977.88
| Facility | | $16,595.87 | $42,657.95 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $26,915.35 / $48,977.88
| Facility | | $138.04 | $26,915.35 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,589.25 / $56,234.13
| Facility | | $5,370.32 | $12,589.25 | $56,234.13 |