- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,585.78 / $14,454.40
| Facility | | $4,265.80 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $30,199.52 / $58,884.37
| Facility | | $23,442.29 | $30,199.52 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,122.02 / $21,877.62
| Facility | | $524.81 | $1,122.02 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,230.27 / $1,621.81
| Professional | | $1,174.90 | $1,230.27 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,964.78 / $17,378.01
| Facility | | $9,120.11 | $10,964.78 | $17,378.01 |