- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,677.35 / $16,982.44
| Facility | | $2,041.74 | $4,677.35 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $14,454.40 / $19,498.45
| Facility | | $10,715.19 | $14,454.40 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $11,748.98 / $17,782.79
| Facility | | $10,471.29 | $11,748.98 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $2,137.96 / $11,748.98
| Professional | | $30.20 | $2,137.96 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $14,454.40 / $26,915.35
| Facility | | $3,715.35 | $14,454.40 | $26,915.35 |