- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $7,943.28 / $14,454.40
| Facility | | $1,513.56 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,022.64 / $23,442.29
| Facility | | $9,120.11 | $12,022.64 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,318.26 / $13,803.84
| Facility | | $758.58 | $1,318.26 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,737.80 / $2,454.71
| Professional | | $1,698.24 | $1,737.80 | $2,454.71 |
- 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 |