- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,907.00 / $52,072.54 / $69,452.10
| Facility | | $6,907.00 | $52,072.54 | $69,452.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.83 / $590.49 / $605.12
| Professional | | $563.83 | $590.49 | $605.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.80 / $770.31 / $878.50
| Professional | | $551.80 | $770.31 | $878.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,271.81 / $31,271.81 / $43,356.43
| Facility | | $31,271.81 | $31,271.81 | $43,356.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.52 / $725.43 / $1,376.78
| Professional | | $594.52 | $725.43 | $1,376.78 |