- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,801.89 / $12,589.25
| Facility | | $1,479.11 | $3,801.89 | $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
- $234.42 / $891.25 / $2,041.74
| Facility | | $234.42 | $891.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,318.26 / $2,344.23
| Professional | | $446.68 | $1,318.26 | $2,344.23 |
- 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 |