- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,467.37 / $22,908.68
| Facility | | $1,148.15 | $3,467.37 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,762.47 / $19,952.62
| Facility | | $6,025.60 | $7,762.47 | $19,952.62 |
- 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
- $323.59 / $489.78 / $3,311.31
| Professional | | $323.59 | $489.78 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $44,668.36 / $79,432.82
| Facility | | $1,659.59 | $44,668.36 | $79,432.82 |