- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $12,022.64 / $19,498.45
| Facility | | $6,309.57 | $12,022.64 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $13,803.84 / $26,915.35
| Facility | | $10,715.19 | $13,803.84 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $7,079.46 / $12,302.69
| Facility | | $512.86 | $7,079.46 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $12,022.64 / $16,982.44
| Professional | | $891.25 | $12,022.64 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,772.37 / $13,803.84
| Facility | | $7,079.46 | $9,772.37 | $13,803.84 |