- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $15,488.17 / $38,018.94
| Facility | | $4,073.80 | $15,488.17 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $16,218.10 / $16,218.10
| Professional | | $3,715.35 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $26,915.35 / $81,283.05
| Facility | | $16,982.44 | $26,915.35 | $81,283.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $26,915.35 / $51,286.14
| Facility | | $7,585.78 | $26,915.35 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $11,220.18 / $54,954.09
| Facility | | $1,584.89 | $11,220.18 | $54,954.09 |