- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,073.80 / $11,220.18
| Facility | | $1,202.26 | $4,073.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $16,595.87
| Professional | | $912.01 | $912.01 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $28,840.32 / $46,773.51
| Facility | | $18,620.87 | $28,840.32 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $15,848.93
| Facility | | $5,495.41 | $5,495.41 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $8,709.64 / $28,183.83
| Facility | | $912.01 | $8,709.64 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $12,589.25 / $30,199.52
| Facility | | $3,467.37 | $12,589.25 | $30,199.52 |