- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,943.28 / $14,454.40
| Facility | | $2,137.96 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $14,454.40 / $28,183.83
| Facility | | $10,964.78 | $14,454.40 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,187.76 / $12,589.25
| Facility | | $1,348.96 | $2,187.76 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,754.23 / $3,801.89
| Professional | | $2,630.27 | $2,754.23 | $3,801.89 |
- 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 |