- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.29 / $5,909.48 / $13,841.56
| Facility | | $2,166.29 | $5,909.48 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.19 / $475.94 / $710.53
| Professional | | $161.19 | $475.94 | $710.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,218.81 / $10,465.26 / $18,365.84
| Facility | | $7,218.81 | $10,465.26 | $18,365.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.50 / $1,561.92 / $7,934.00
| Facility | | $1,105.50 | $1,561.92 | $7,934.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.73 / $68.73 / $84.10
| Professional | | $68.73 | $68.73 | $84.10 |