- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,585.78 / $14,454.40
| Facility | | $4,265.80 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,760.83 / $13,182.57
| Facility | | $5,248.07 | $6,760.83 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $676.08 / $8,912.51
| Facility | | $346.74 | $676.08 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $758.58 / $1,071.52
| Professional | | $741.31 | $758.58 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,918.31 / $8,912.51
| Facility | | $6,165.95 | $6,918.31 | $8,912.51 |