- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,244.36 / $12,589.25
| Facility | | $2,344.23 | $7,244.36 | $12,589.25 |
- 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
- $275.42 / $478.63 / $3,019.95
| Facility | | $275.42 | $478.63 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $707.95 / $912.01
| Professional | | $575.44 | $707.95 | $912.01 |
- 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 |