- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $6,456.54 / $11,481.54
| Facility | | $758.58 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,606.93 / $13,489.63
| Facility | | $5,248.07 | $6,606.93 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $3,090.30
| Facility | | $346.74 | $602.56 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $1,148.15
| Professional | | $724.44 | $891.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,235.94 / $8,128.31
| Facility | | $2,398.83 | $3,235.94 | $8,128.31 |