- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $8,317.64 / $18,197.01
| Facility | | $3,630.78 | $8,317.64 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $19,054.61
| Professional | | $933.25 | $933.25 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,489.63 / $17,378.01
| Facility | | $7,943.28 | $13,489.63 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,964.78 / $33,884.42
| Facility | | $7,585.78 | $10,964.78 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $8,511.38 / $21,877.62
| Facility | | $2,041.74 | $8,511.38 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $10,715.19 / $17,378.01
| Facility | | $2,951.21 | $10,715.19 | $17,378.01 |