- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $7,943.28 / $14,454.40
| Facility | | $1,318.26 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $23,988.33 / $46,773.51
| Facility | | $18,620.87 | $23,988.33 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $7,943.28
| Facility | | $794.33 | $1,174.90 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,584.89 / $2,187.76
| Professional | | $1,513.56 | $1,584.89 | $2,187.76 |
- 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 |