- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,011.87 / $7,244.36
| Facility | | $4,677.35 | $5,011.87 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $2,818.38
| Professional | | $1,819.70 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,153.52 / $75,857.76 / $218,776.16
| Facility | | $37,153.52 | $75,857.76 | $218,776.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $13,182.57 / $79,432.82
| Facility | | $5,888.44 | $13,182.57 | $79,432.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $10,964.78 / $77,624.71
| Facility | | $1,584.89 | $10,964.78 | $77,624.71 |