- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $38,904.51 / $75,857.76
| Facility | | $14,454.40 | $38,904.51 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $23,442.29 / $57,543.99
| Facility | | $17,378.01 | $23,442.29 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,317.64 / $9,549.93
| Professional | | $7,079.46 | $8,317.64 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,981.07 / $5,370.32
| Facility | | $2,570.40 | $3,981.07 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,548.13 / $6,165.95
| Professional | | $3,388.44 | $3,548.13 | $6,165.95 |