- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,943.28 / $14,454.40
| Facility | | $2,754.23 | $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
- $1,445.44 / $2,511.89 / $13,803.84
| Facility | | $1,445.44 | $2,511.89 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,388.44 / $4,677.35
| Professional | | $3,235.94 | $3,388.44 | $4,677.35 |
- 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 |