- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,943.28 / $13,489.63
| Facility | | $4,365.16 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,595.87 / $32,359.37
| Facility | | $12,882.50 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,071.52 / $26,915.35
| Facility | | $575.44 | $1,071.52 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | 53 | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,148.15 / $1,584.89
| Professional | | $1,096.48 | $1,148.15 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,022.64 / $23,988.33
| Facility | | $9,772.37 | $12,022.64 | $23,988.33 |