- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $7,943.28 / $14,454.40
| Facility | | $1,905.46 | $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
- $1,202.26 / $2,137.96 / $13,489.63
| Facility | | $1,202.26 | $2,137.96 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,454.71 / $3,388.44
| Professional | | $2,344.23 | $2,454.71 | $3,388.44 |
- 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 |