- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,975.77 / $22,021.17
| Facility | | $5,463.36 | $10,975.77 | $22,021.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.00 / $9,185.68 / $12,765.09
| Professional | | $1,161.00 | $9,185.68 | $12,765.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,638.95 / $13,993.13 / $27,067.23
| Facility | | $10,638.95 | $13,993.13 | $27,067.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,496.00 / $15,622.00 / $29,914.78
| Facility | | $9,496.00 | $15,622.00 | $29,914.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,745.88 / $21,138.19 / $29,368.54
| Facility | | $18,745.88 | $21,138.19 | $29,368.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |