- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,549.93 / $18,197.01
| Facility | | $5,370.32 | $9,549.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $20,417.38 / $39,810.72
| Facility | | $15,488.17 | $20,417.38 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,818.38 / $16,982.44
| Facility | | $1,513.56 | $2,818.38 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,884.03 / $3,311.31
| Professional | | $2,570.40 | $2,884.03 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,511.38 / $17,378.01
| Facility | | $7,079.46 | $8,511.38 | $17,378.01 |