- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $12,022.64 / $20,892.96
| Facility | | $7,244.36 | $12,022.64 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $21,379.62 / $41,686.94
| Facility | | $16,595.87 | $21,379.62 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,659.59 / $21,379.62
| Facility | | $457.09 | $1,659.59 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,698.24 / $2,454.71
| Professional | | $1,096.48 | $1,698.24 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,964.78 / $16,982.44
| Facility | | $9,120.11 | $10,964.78 | $16,982.44 |