- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,466.84 / $19,054.61
| Facility | | $1,862.09 | $4,466.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $15,135.61 / $19,054.61
| Facility | | $10,964.78 | $15,135.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $19,952.62 / $20,892.96
| Facility | | $17,782.79 | $19,952.62 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $1,380.38 / $12,022.64
| Professional | | $15.85 | $1,380.38 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,606.93 / $30,199.52
| Facility | | $3,715.35 | $6,606.93 | $30,199.52 |