- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $12,036.14 / $24,068.03
| Facility | | $5,463.36 | $12,036.14 | $24,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.00 / $2,367.27 / $13,783.32
| Professional | | $1,161.00 | $2,367.27 | $13,783.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,547.24 / $20,448.87 / $39,554.72
| Facility | | $15,547.24 | $20,448.87 | $39,554.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,496.00 / $15,622.00 / $29,914.78
| Facility | | $9,496.00 | $15,622.00 | $29,914.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |