- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,128.61 / $14,125.38
| Facility | | $3,981.07 | $5,128.61 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,182.57 / $17,378.01
| Facility | | $7,943.28 | $13,182.57 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $16,982.44 / $17,782.79
| Facility | | $5,128.61 | $16,982.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,174.90 / $7,943.28
| Professional | | $776.25 | $1,174.90 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,786.30 / $12,022.64
| Facility | | $2,951.21 | $4,786.30 | $12,022.64 |