- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,073.80 / $12,589.25
| Facility | | $2,041.74 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,589.25 / $24,547.09
| Facility | | $9,772.37 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,318.26 / $15,488.17
| Facility | | $602.56 | $1,318.26 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,445.44 / $1,862.09
| Professional | | $1,348.96 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,413.10 / $12,589.25
| Facility | | $4,786.30 | $7,413.10 | $12,589.25 |