- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $14,791.08 / $31,622.78
| Facility | | $3,311.31 | $14,791.08 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $23,988.33 / $46,773.51
| Facility | | $6,918.31 | $23,988.33 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $2,137.96
| Facility | | $34.67 | $562.34 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,995.26
| Professional | | $1,621.81 | $1,621.81 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,659.59 / $2,630.27
| Facility | | $1,230.27 | $1,659.59 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $21,877.62 / $37,153.52
| Facility | | $3,311.31 | $21,877.62 | $37,153.52 |