- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,943.28 / $23,442.29
| Facility | | $4,466.84 | $7,943.28 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,748.98 / $16,218.10
| Professional | | $5,495.41 | $11,748.98 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,413.10 / $30,199.52
| Facility | | $2,137.96 | $7,413.10 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $3.98 / $3.98
| Professional | | $3.98 | $3.98 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $20,892.96 / $23,988.33
| Facility | | $11,748.98 | $20,892.96 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $19,498.45 / $20,892.96
| Facility | | $9,120.11 | $19,498.45 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,125.38
| Facility | | $14,125.38 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,589.25 / $31,622.78
| Facility | | $5,370.32 | $12,589.25 | $31,622.78 |