- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,073.80 / $10,715.19
| Facility | | $1,513.56 | $4,073.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,148.15
| Professional | | $912.01 | $912.01 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,964.78 / $17,378.01
| Facility | | $5,754.40 | $10,964.78 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $17,782.79 / $19,498.45
| Professional | | $11,220.18 | $17,782.79 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $14,125.38 / $23,442.29
| Facility | | $8,709.64 | $14,125.38 | $23,442.29 |
- 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 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $13,803.84 / $25,118.86
| Facility | | $6,456.54 | $13,803.84 | $25,118.86 |