- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,943.28 / $14,454.40
| Facility | | $6,456.54 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $23,988.33 / $46,773.51
| Facility | | $18,620.87 | $23,988.33 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,248.07 / $64,565.42
| Facility | | $3,715.35 | $5,248.07 | $64,565.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $8,128.31 / $10,964.78
| Professional | | $7,762.47 | $8,128.31 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |