- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,022.64 / $21,877.62
| Facility | | $8,912.51 | $12,022.64 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $15,135.61 / $15,135.61
| Professional | | $3,019.95 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,456.54 / $20,892.96
| Facility | | $1,819.70 | $6,456.54 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $22,908.68 / $25,703.96
| Facility | | $16,595.87 | $22,908.68 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |