- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,317.64 / $14,454.40
| Facility | | $3,162.28 | $8,317.64 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $3,630.78
| Professional | | $912.01 | $912.01 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,489.63 / $17,378.01
| Facility | | $7,943.28 | $13,489.63 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,964.78 / $33,884.42
| Facility | | $7,585.78 | $10,964.78 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,888.44 / $21,877.62
| Facility | | $912.01 | $5,888.44 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $10,715.19 / $17,378.01
| Facility | | $2,951.21 | $10,715.19 | $17,378.01 |