- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,943.28 / $14,454.40
| Facility | | $2,290.87 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,220.18 / $21,877.62
| Facility | | $8,511.38 | $11,220.18 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,995.26 / $13,803.84
| Facility | | $1,202.26 | $1,995.26 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $3,801.89
| Professional | | $2,630.27 | $2,630.27 | $3,801.89 |
- 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 |