- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,079.46 / $18,620.87
| Facility | | $2,570.40 | $7,079.46 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $3,162.28
| Facility | | $489.78 | $575.44 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Professional | | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,238.72 / $3,630.78
| Facility | | $1,737.80 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $8,709.64 / $19,952.62
| Facility | | $1,737.80 | $8,709.64 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $25,118.86 / $25,118.86
| Facility | | $2,818.38 | $25,118.86 | $25,118.86 |