- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,943.28 / $13,489.63
| Facility | | $4,365.16 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,595.87 / $32,359.37
| Facility | | $12,882.50 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $776.25 / $31,622.78
| Facility | | $407.38 | $776.25 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $812.83 / $1,122.02
| Professional | | $776.25 | $812.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $13,489.63 / $25,703.96
| Facility | | $9,120.11 | $13,489.63 | $25,703.96 |