- 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
- $1,202.26 / $1,659.59 / $3,981.07
| Facility | | $1,202.26 | $1,659.59 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,202.26 / $1,905.46
| Professional | | $870.96 | $1,202.26 | $1,905.46 |
- 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
- $234.42 / $275.42 / $1,148.15
| Professional | | $234.42 | $275.42 | $1,148.15 |