- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,549.93 / $18,197.01
| Facility | | $5,370.32 | $9,549.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $11,220.18 / $21,877.62
| Facility | | $8,709.64 | $11,220.18 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,951.21 / $12,589.25
| Facility | | $1,318.26 | $2,951.21 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,235.94 / $4,168.69
| Professional | | $2,951.21 | $3,235.94 | $4,168.69 |
- 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 |