- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,981.07 / $10,232.93
| Facility | | $1,348.96 | $3,981.07 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,182.57 / $17,378.01
| Facility | | $7,943.28 | $13,182.57 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $14,454.40 / $14,791.08
| Facility | | $13,182.57 | $14,454.40 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $2,570.40 / $3,630.78
| Professional | | $30.20 | $2,570.40 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,570.40 / $6,606.93
| Facility | | $1,071.52 | $2,570.40 | $6,606.93 |