- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,943.28 / $15,135.61
| Facility | | $6,025.60 | $7,943.28 | $15,135.61 |
- 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
- $977.24 / $2,089.30 / $8,912.51
| Facility | | $977.24 | $2,089.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,290.87 / $3,090.30
| Professional | | $2,187.76 | $2,290.87 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,606.93 / $8,912.51
| Facility | | $4,677.35 | $6,606.93 | $8,912.51 |