- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,073.80 / $12,589.25
| Facility | | $1,548.82 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,709.64 / $16,982.44
| Facility | | $6,606.93 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $870.96 / $2,691.53
| Facility | | $501.19 | $870.96 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $1,819.70
| Professional | | $1,047.13 | $1,288.25 | $1,819.70 |
- 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 |