- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,265.80 / $6,918.31
| Facility | | $1,348.96 | $4,265.80 | $6,918.31 |
- 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
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $891.25 / $4,677.35
| Professional | | $14.13 | $891.25 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,677.35 / $12,022.64
| Facility | | $2,951.21 | $4,677.35 | $12,022.64 |