- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,801.89 / $75,857.76
| Facility | | $2,137.96 | $3,801.89 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,218.10 / $20,892.96
| Facility | | $11,748.98 | $16,218.10 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $13,182.57 / $15,848.93
| Facility | | $11,748.98 | $13,182.57 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $38,904.51
| Professional | | $363.08 | $562.34 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $26,302.68
| Facility | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $44,668.36 / $79,432.82
| Facility | | $7,585.78 | $44,668.36 | $79,432.82 |