- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,549.93 / $18,197.01
| Facility | | $5,370.32 | $9,549.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $19,498.45 / $39,810.72
| Facility | | $15,488.17 | $19,498.45 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,754.23 / $9,772.37
| Facility | | $1,479.11 | $2,754.23 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,818.38 / $3,235.94
| Professional | | $2,454.71 | $2,818.38 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,128.31 / $10,000.00
| Facility | | $7,079.46 | $8,128.31 | $10,000.00 |