- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,981.07 / $10,232.93
| Facility | | $2,754.23 | $3,981.07 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,332.54 / $10,964.78
| Facility | | $5,370.32 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $16,982.44 / $17,782.79
| Facility | | $3,019.95 | $16,982.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $4,786.30
| Professional | | $602.56 | $912.01 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,677.35 / $12,022.64
| Facility | | $2,951.21 | $4,677.35 | $12,022.64 |