- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $4,466.84 / $11,481.54
| Facility | | $446.68 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,073.80 / $7,943.28
| Facility | | $3,090.30 | $4,073.80 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $3,019.95
| Facility | | $208.93 | $363.08 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $707.95
| Professional | | $436.52 | $537.03 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $8,128.31
| Facility | | $2,398.83 | $3,162.28 | $8,128.31 |