- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,943.28 / $14,454.40
| Facility | | $2,344.23 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,471.29 / $20,417.38
| Facility | | $7,943.28 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,137.96 / $4,265.80
| Facility | | $1,230.27 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,090.30 / $4,168.69
| Professional | | $2,570.40 | $3,090.30 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,365.16 / $8,128.31
| Facility | | $3,467.37 | $4,365.16 | $8,128.31 |