- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,943.28 / $14,454.40
| Facility | | $2,818.38 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $13,182.57 / $25,703.96
| Facility | | $10,232.93 | $13,182.57 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,454.71 / $13,803.84
| Facility | | $1,513.56 | $2,454.71 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,311.31 / $4,677.35
| Professional | | $3,235.94 | $3,311.31 | $4,677.35 |
- 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 |