- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,011.87 / $13,489.63
| Facility | | $2,344.23 | $5,011.87 | $13,489.63 |
- 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
- $724.44 / $1,584.89 / $12,022.64
| Facility | | $724.44 | $1,584.89 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,737.80 / $2,290.87
| Professional | | $1,621.81 | $1,737.80 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,079.46 / $12,589.25
| Facility | | $3,715.35 | $7,079.46 | $12,589.25 |