- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,365.16 / $10,964.78
| Facility | | $1,258.93 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,456.54 / $12,589.25
| Facility | | $5,011.87 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,148.15 / $7,943.28
| Facility | | $537.03 | $1,148.15 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,258.93 / $1,659.59
| Professional | | $1,174.90 | $1,258.93 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,370.32 / $8,128.31
| Facility | | $3,630.78 | $5,370.32 | $8,128.31 |