- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,888.44 / $12,022.64
| Facility | | $2,454.71 | $5,888.44 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $10,232.93 / $11,220.18
| Professional | | $1,071.52 | $10,232.93 | $11,220.18 |
- 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
- $64.57 / $64.57 / $53,703.18
| Facility | | $64.57 | $64.57 | $53,703.18 |
- 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 / $10,471.29
| Facility | | $2,137.96 | $4,365.16 | $10,471.29 |