- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,943.28 / $14,454.40
| Facility | | $1,995.26 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,244.36 / $14,125.38
| Facility | | $5,495.41 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,584.89 / $3,715.35
| Facility | | $977.24 | $1,584.89 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,454.71 / $3,388.44
| Professional | | $2,041.74 | $2,454.71 | $3,388.44 |
- 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 |