- 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
- $6,918.31 / $8,912.51 / $17,378.01
| Facility | | $6,918.31 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,698.24 / $10,964.78
| Facility | | $794.33 | $1,698.24 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,862.09 / $2,511.89
| Professional | | $1,778.28 | $1,862.09 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,456.54 / $8,912.51
| Facility | | $3,715.35 | $6,456.54 | $8,912.51 |