- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,073.80 / $12,589.25
| Facility | | $2,041.74 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,951.21 / $5,754.40
| Facility | | $2,238.72 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $173.78 / $331.13
| Facility | | $102.33 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $263.03 / $371.54
| Professional | | $213.80 | $263.03 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $8,317.64
| Facility | | $2,630.27 | $3,311.31 | $8,317.64 |