- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,719.00 / $20,928.72
| Facility | | $5,463.36 | $10,719.00 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.00 / $1,556.10 / $12,765.09
| Professional | | $1,161.00 | $1,556.10 | $12,765.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,731.81 / $33,844.37 / $65,465.93
| Facility | | $25,731.81 | $33,844.37 | $65,465.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,221.00 / $34,233.37 / $45,814.13
| Facility | | $11,221.00 | $34,233.37 | $45,814.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,221.00 / $14,989.00 / $44,635.00
| Facility | | $11,221.00 | $14,989.00 | $44,635.00 |