- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,471.29 / $19,952.62
| Facility | | $4,897.79 | $10,471.29 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,000.00 / $19,498.45
| Facility | | $7,585.78 | $10,000.00 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $467.74 / $7,943.28
| Facility | | $141.25 | $467.74 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $288.40 / $398.11
| Professional | | $275.42 | $288.40 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |