- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,011.87 / $12,589.25
| Facility | | $1,148.15 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,365.16 / $8,511.38
| Facility | | $3,311.31 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,819.70 / $8,912.51
| Facility | | $831.76 | $1,819.70 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,089.30 / $2,884.03
| Professional | | $1,778.28 | $2,089.30 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,495.41 / $8,912.51
| Facility | | $4,365.16 | $5,495.41 | $8,912.51 |