- 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
- $15,172.22 / $19,955.61 / $38,600.60
| Facility | | $15,172.22 | $19,955.61 | $38,600.60 |
- 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
- $17,454.24 / $20,945.09 / $27,344.98
| Facility | | $17,454.24 | $20,945.09 | $27,344.98 |
- 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 |