- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $20,417.38 / $23,988.33
| Facility | | $7,762.47 | $20,417.38 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,128.31 / $14,791.08
| Facility | | $6,760.83 | $8,128.31 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $16,595.87 / $23,988.33
| Facility | | $6,165.95 | $16,595.87 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $54.95 / $85.11
| Professional | | $32.36 | $54.95 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $18,197.01 / $19,952.62
| Facility | | $17,378.01 | $18,197.01 | $19,952.62 |