- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,165.95 / $11,748.98
| Facility | | $2,454.71 | $6,165.95 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $7,943.28 / $10,232.93
| Professional | | $1,023.29 | $7,943.28 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,995.26 / $6,025.60
| Facility | | $1,905.46 | $1,995.26 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $53,703.18
| Facility | | $64.57 | $64.57 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $9,332.54 / $12,022.64
| Facility | | $4,073.80 | $9,332.54 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,365.16 / $11,220.18
| Facility | | $2,137.96 | $4,365.16 | $11,220.18 |