- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,011.87 / $12,589.25
| Facility | | $2,344.23 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,000.00 / $19,498.45
| Facility | | $7,585.78 | $10,000.00 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $446.68 / $8,912.51
| Facility | | $190.55 | $446.68 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $467.74 / $616.60
| Professional | | $416.87 | $467.74 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,623.41 / $8,912.51
| Facility | | $4,677.35 | $5,623.41 | $8,912.51 |