- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,466.84 / $32,359.37
| Facility | | $2,137.96 | $4,466.84 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,182.57 / $17,378.01
| Facility | | $7,943.28 | $13,182.57 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $229.09 / $7,079.46
| Professional | | $158.49 | $229.09 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,786.30 / $19,054.61
| Facility | | $2,951.21 | $4,786.30 | $19,054.61 |