- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,549.93 / $17,782.79
| Facility | | $6,025.60 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $20,417.38 / $39,810.72
| Facility | | $15,488.17 | $20,417.38 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,348.96 / $17,378.01
| Facility | | $691.83 | $1,348.96 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,348.96 / $1,548.82
| Professional | | $1,174.90 | $1,348.96 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $17,378.01
| Facility | | $8,709.64 | $13,489.63 | $17,378.01 |