- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $7,244.36 / $13,489.63
| Facility | | $1,778.28 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,000.00 / $19,498.45
| Facility | | $7,585.78 | $10,000.00 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $630.96 / $4,365.16
| Facility | | $190.55 | $630.96 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $588.84 / $776.25
| Professional | | $338.84 | $588.84 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $4,570.88
| Facility | | $1,096.48 | $1,548.82 | $4,570.88 |