- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,466.84 / $10,232.93
| Facility | | $323.59 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Facility | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $16,982.44 / $17,782.79
| Facility | | $15,848.93 | $16,982.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $309.03 / $467.74
| Professional | | $5.62 | $309.03 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,786.30 / $12,022.64
| Facility | | $2,951.21 | $4,786.30 | $12,022.64 |