- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,466.84 / $10,232.93
| Facility | | $2,137.96 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,762.47 / $19,498.45
| Facility | | $5,754.40 | $7,762.47 | $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
- $18.20 / $1,949.84 / $2,818.38
| Professional | | $18.20 | $1,949.84 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,905.46 / $6,606.93
| Facility | | $776.25 | $1,905.46 | $6,606.93 |