- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,818.38 / $5,888.44
| Facility | | $1,148.15 | $2,818.38 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,022.64 / $14,454.40
| Facility | | $7,413.10 | $12,022.64 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $933.25 / $6,165.95
| Professional | | $9.55 | $933.25 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,548.13 / $10,715.19
| Facility | | $2,290.87 | $3,548.13 | $10,715.19 |