- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,943.28 / $13,489.63
| Facility | | $4,365.16 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,595.87 / $32,359.37
| Facility | | $12,882.50 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $724.44 / $15,488.17
| Facility | | $380.19 | $724.44 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $758.58 / $1,047.13
| Professional | | $724.44 | $758.58 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,000.00 / $14,125.38
| Facility | | $8,317.64 | $10,000.00 | $14,125.38 |