- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,659.59 / $2,454.71
| Facility | | $870.96 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $223.87 / $398.11
| Professional | | $131.83 | $223.87 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $5,248.07
| Facility | | $3,801.89 | $3,801.89 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,951.21 / $10,471.29
| Facility | | $1,230.27 | $2,951.21 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $281.84 / $457.09
| Professional | | $204.17 | $281.84 | $457.09 |