- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,943.28 / $14,454.40
| Facility | | $4,466.84 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $16,595.87 / $32,359.37
| Facility | | $12,589.25 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,388.44 / $5,248.07
| Facility | | $1,995.26 | $3,388.44 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,495.41 / $7,585.78
| Professional | | $4,570.88 | $5,495.41 | $7,585.78 |
- 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 |