- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,466.84 / $10,232.93
| Facility | | $1,862.09 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,332.54 / $12,882.50
| Facility | | $5,370.32 | $9,332.54 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $16,982.44 / $17,782.79
| Facility | | $15,848.93 | $16,982.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $1,698.24 / $2,454.71
| Professional | | $17.38 | $1,698.24 | $2,454.71 |
- 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 |