- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.51 / $288.45 / $605.42
| Professional | | $151.51 | $288.45 | $605.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,937.84 / $8,608.20 / $15,106.84
| Facility | | $5,937.84 | $8,608.20 | $15,106.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.08 / $670.50 / $4,406.00
| Facility | | $289.08 | $670.50 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |