- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,897.79 / $7,762.47
| Facility | | $1,949.84 | $4,897.79 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $5,888.44
| Facility | | $3,388.44 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $794.33 / $1,862.09
| Professional | | $14.45 | $794.33 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,344.23 / $7,244.36
| Facility | | $1,288.25 | $2,344.23 | $7,244.36 |