- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,365.16 / $9,772.37
| Facility | | $1,348.96 | $4,365.16 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,454.40 / $20,892.96
| Facility | | $8,912.51 | $14,454.40 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $14,791.08
| Facility | | $14,791.08 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $1,412.54 / $16,982.44
| Professional | | $14.45 | $1,412.54 | $16,982.44 |
- 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 |