- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,466.84 / $41,686.94
| Facility | | $2,137.96 | $4,466.84 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $14,454.40 / $20,892.96
| Facility | | $10,715.19 | $14,454.40 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $15,848.93
| Facility | | $13,803.84 | $13,803.84 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $21,379.62
| Professional | | $338.84 | $524.81 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,125.38
| Facility | | $14,125.38 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $20,892.96 / $34,673.69
| Facility | | $4,786.30 | $20,892.96 | $34,673.69 |