- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,801.89 / $12,589.25
| Facility | | $2,041.74 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,370.32 / $10,471.29
| Facility | | $4,073.80 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $1,949.84
| Facility | | $154.88 | $257.04 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $389.05 / $524.81
| Professional | | $323.59 | $389.05 | $524.81 |
- 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 |