- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,943.28 / $14,454.40
| Facility | | $5,754.40 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,471.29 / $20,417.38
| Facility | | $8,128.31 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,148.15 / $7,943.28
| Facility | | $549.54 | $1,148.15 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,258.93 / $1,778.28
| Professional | | $1,230.27 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,897.79 / $8,128.31
| Facility | | $3,630.78 | $4,897.79 | $8,128.31 |