- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,025.60 / $10,715.19
| Facility | | $4,365.16 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $7,943.28 / $12,302.69
| Professional | | $3,090.30 | $7,943.28 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $28,183.83 / $33,113.11
| Facility | | $22,387.21 | $28,183.83 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,964.78 / $17,378.01
| Facility | | $6,918.31 | $10,964.78 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,918.31 / $15,135.61
| Facility | | $2,454.71 | $6,918.31 | $15,135.61 |