- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $15,848.93 / $31,622.78
| Facility | | $1,584.89 | $15,848.93 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $10,232.93
| Professional | | $676.08 | $676.08 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $18,197.01 / $30,199.52
| Facility | | $14,791.08 | $18,197.01 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $19,498.45 / $44,668.36
| Facility | | $16,595.87 | $19,498.45 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $28,183.83 / $50,118.72
| Facility | | $3,311.31 | $28,183.83 | $50,118.72 |