- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,884.03 / $5,888.44
| Facility | | $1,202.26 | $2,884.03 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,025.60 / $7,762.47
| Facility | | $4,466.84 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $16,982.44 / $17,782.79
| Facility | | $15,848.93 | $16,982.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $1,096.48 / $1,584.89
| Professional | | $14.13 | $1,096.48 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,090.30 / $9,120.11
| Facility | | $1,096.48 | $3,090.30 | $9,120.11 |