- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,943.28 / $14,454.40
| Facility | | $6,025.60 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,332.54 / $18,197.01
| Facility | | $7,244.36 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,513.56 / $3,019.95
| Facility | | $933.25 | $1,513.56 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,398.83 / $3,235.94
| Professional | | $1,949.84 | $2,398.83 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,495.41 / $8,912.51
| Facility | | $4,365.16 | $5,495.41 | $8,912.51 |