- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,943.28 / $14,454.40
| Facility | | $4,466.84 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,471.29 / $20,417.38
| Facility | | $7,943.28 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,073.80 / $13,803.84
| Facility | | $2,511.89 | $4,073.80 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,888.44 / $7,762.47
| Professional | | $5,495.41 | $5,888.44 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |