- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $4,466.84 / $12,589.25
| Facility | | $562.34 | $4,466.84 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,709.64 / $16,982.44
| Facility | | $6,760.83 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $524.81 / $8,912.51
| Facility | | $275.42 | $524.81 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $549.54 / $758.58
| Professional | | $537.03 | $549.54 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,495.41 / $8,912.51
| Facility | | $3,890.45 | $5,495.41 | $8,912.51 |