- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,011.87 / $12,589.25
| Facility | | $2,344.23 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $13,489.63 / $26,302.68
| Facility | | $10,232.93 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,348.96 / $4,786.30
| Facility | | $758.58 | $1,348.96 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,905.46 / $2,511.89
| Professional | | $1,819.70 | $1,905.46 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,162.28 / $8,128.31
| Facility | | $645.65 | $3,162.28 | $8,128.31 |