- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,943.28 / $13,489.63
| Facility | | $4,466.84 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,943.28 / $15,488.17
| Facility | | $6,025.60 | $7,943.28 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $489.78 / $7,244.36
| Facility | | $281.84 | $489.78 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $691.83 / $933.25
| Professional | | $588.84 | $691.83 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,011.87 / $8,128.31
| Facility | | $3,630.78 | $5,011.87 | $8,128.31 |