- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,801.89 / $12,589.25
| Facility | | $630.96 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,467.37 / $6,760.83
| Facility | | $2,691.53 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $257.04 / $616.60
| Facility | | $102.33 | $257.04 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $512.86 / $741.31
| Professional | | $229.09 | $512.86 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,162.28 / $8,128.31
| Facility | | $1,479.11 | $3,162.28 | $8,128.31 |