- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $11,481.54 / $40,738.03
| Facility | | $4,570.88 | $11,481.54 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $16,218.10 / $16,595.87
| Professional | | $6,025.60 | $16,218.10 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $39,810.72 / $48,977.88
| Facility | | $16,595.87 | $39,810.72 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $34,673.69 / $52,480.75
| Facility | | $1,737.80 | $34,673.69 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,589.25 / $56,234.13
| Facility | | $5,370.32 | $12,589.25 | $56,234.13 |