- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,466.84 / $11,481.54
| Facility | | $912.01 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,606.93 / $12,882.50
| Facility | | $5,128.61 | $6,606.93 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $489.78 / $4,786.30
| Facility | | $223.87 | $489.78 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,096.48
| Professional | | $549.54 | $776.25 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,365.16 / $8,128.31
| Facility | | $3,630.78 | $4,365.16 | $8,128.31 |