- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $6,309.57 / $11,481.54
| Facility | | $870.96 | $6,309.57 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,244.36 / $14,125.38
| Facility | | $5,495.41 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $676.08 / $1,380.38
| Facility | | $398.11 | $676.08 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,230.27 / $1,548.82
| Professional | | $933.25 | $1,230.27 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,365.16 / $8,128.31
| Facility | | $3,467.37 | $4,365.16 | $8,128.31 |