- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $7,943.28 / $14,454.40
| Facility | | $1,318.26 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,317.64 / $16,218.10
| Facility | | $6,456.54 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,202.26 / $5,754.40
| Facility | | $691.83 | $1,202.26 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,584.89 / $2,187.76
| Professional | | $1,548.82 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |