- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,317.64 / $15,848.93
| Facility | | $4,786.30 | $8,317.64 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,819.70 / $4,265.80
| Facility | | $1,288.25 | $1,819.70 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,288.25 / $2,041.74
| Professional | | $933.25 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,165.95 / $14,125.38
| Facility | | $2,884.03 | $6,165.95 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $194.98 / $1,148.15
| Professional | | $165.96 | $194.98 | $1,148.15 |