- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,073.80 / $12,589.25
| Facility | | $2,041.74 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $12,302.69 / $23,988.33
| Facility | | $9,549.93 | $12,302.69 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $251.19 / $4,365.16
| Facility | | $144.54 | $251.19 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $371.54 / $512.86
| Professional | | $354.81 | $371.54 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $4,570.88
| Facility | | $1,096.48 | $1,548.82 | $4,570.88 |