- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $14,454.40 / $22,908.68
| Facility | | $912.01 | $14,454.40 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $2,570.40
| Professional | | $912.01 | $912.01 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $27,542.29 / $32,359.37
| Facility | | $15,848.93 | $27,542.29 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $977.24 / $2,511.89
| Facility | | $912.01 | $977.24 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $21,877.62 / $33,113.11
| Facility | | $9,549.93 | $21,877.62 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66,069.34 / $66,069.34 / $66,069.34
| Facility | | $66,069.34 | $66,069.34 | $66,069.34 |