- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,511.38 / $16,982.44
| Facility | | $3,388.44 | $8,511.38 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,698.24 / $4,168.69
| Facility | | $1,230.27 | $1,698.24 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,380.38 / $1,995.26
| Professional | | $812.83 | $1,380.38 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,019.95 / $7,079.46
| Facility | | $1,584.89 | $3,019.95 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $954.99
| Professional | | $398.11 | $562.34 | $954.99 |