- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,943.28 / $14,454.40
| Facility | | $3,467.37 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,715.19 / $20,892.96
| Facility | | $8,317.64 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,630.78 / $13,803.84
| Facility | | $1,862.09 | $3,630.78 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,570.88 / $5,888.44
| Professional | | $4,168.69 | $4,570.88 | $5,888.44 |
- 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 |