- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,981.07 / $6,918.31
| Facility | | $1,348.96 | $3,981.07 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,182.57 / $17,378.01
| Facility | | $7,943.28 | $13,182.57 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $1,202.26 / $11,481.54
| Professional | | $12.30 | $1,202.26 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,677.35 / $12,022.64
| Facility | | $2,951.21 | $4,677.35 | $12,022.64 |