- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $7,943.28 / $14,454.40
| Facility | | $478.63 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,623.41 / $10,964.78
| Facility | | $4,265.80 | $5,623.41 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $562.34 / $7,413.10
| Facility | | $239.88 | $562.34 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $851.14
| Professional | | $501.19 | $588.84 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,495.41 / $8,912.51
| Facility | | $3,630.78 | $5,495.41 | $8,912.51 |