- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $9,332.54 / $32,359.37
| Facility | | $3,162.28 | $9,332.54 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $19,054.61
| Professional | | $933.25 | $933.25 | $19,054.61 |
- 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
- $524.81 / $524.81 / $524.81
| Professional | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $30,902.95 / $72,443.60
| Facility | | $26,302.68 | $30,902.95 | $72,443.60 |
- 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 |