- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $7,943.28 / $14,454.40
| Facility | | $1,778.28 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,715.19 / $20,892.96
| Facility | | $8,317.64 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,659.59 / $7,762.47
| Facility | | $933.25 | $1,659.59 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,238.72 / $2,951.21
| Professional | | $2,089.30 | $2,238.72 | $2,951.21 |
- 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 |