- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $13,182.57 / $30,199.52
| Facility | | $4,466.84 | $13,182.57 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $22,908.68
| Professional | | $22,908.68 | $22,908.68 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $47,863.01 / $83,176.38
| Facility | | $10,232.93 | $47,863.01 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $26,915.35 / $26,915.35
| Facility | | $10,471.29 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $30,902.95 / $60,255.96
| Facility | | $20,417.38 | $30,902.95 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $40,738.03 / $69,183.10
| Facility | | $4,677.35 | $40,738.03 | $69,183.10 |