- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,548.13 / $9,772.37
| Facility | | $1,096.48 | $3,548.13 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $2,511.89 / $10,232.93
| Professional | | $660.69 | $2,511.89 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,623.41 / $12,302.69
| Facility | | $2,089.30 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $53.70 / $97.72
| Professional | | $38.90 | $53.70 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $758.58 / $50,118.72
| Facility | | $323.59 | $758.58 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,370.32 / $12,302.69
| Facility | | $1,548.82 | $5,370.32 | $12,302.69 |