- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,011.87 / $12,302.69
| Facility | | $1,905.46 | $5,011.87 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $10,964.78 / $19,498.45
| Facility | | $9,332.54 | $10,964.78 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,673.69 / $38,018.94 / $39,810.72
| Facility | | $34,673.69 | $38,018.94 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $1,737.80 / $2,511.89
| Professional | | $17.78 | $1,737.80 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,677.35 / $12,022.64
| Facility | | $1,445.44 | $4,677.35 | $12,022.64 |