- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $7,585.78 / $13,489.63
| Facility | | $1,621.81 | $7,585.78 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,698.24 / $3,311.31
| Facility | | $1,318.26 | $1,698.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,778.28 / $8,912.51
| Facility | | $977.24 | $1,778.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,949.84 / $2,691.53
| Professional | | $1,862.09 | $1,949.84 | $2,691.53 |
- 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 |