- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,981.07 / $36,307.81
| Facility | | $1,148.15 | $3,981.07 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $14,125.38 / $17,378.01
| Facility | | $10,715.19 | $14,125.38 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $15,848.93
| Facility | | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $724.44 / $12,022.64
| Professional | | $446.68 | $724.44 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $20,892.96 / $34,673.69
| Facility | | $4,897.79 | $20,892.96 | $34,673.69 |