- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,786.30 / $9,772.37
| Facility | | $2,137.96 | $4,786.30 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,454.40 / $20,892.96
| Facility | | $8,912.51 | $14,454.40 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $9,120.11 / $41,686.94
| Facility | | $8,317.64 | $9,120.11 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $1,071.52 / $1,445.44
| Professional | | $7.24 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,025.60 / $26,302.68
| Facility | | $3,801.89 | $6,025.60 | $26,302.68 |