- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $7,079.46 / $13,182.57
| Facility | | $1,698.24 | $7,079.46 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,456.54 / $12,589.25
| Facility | | $5,011.87 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $691.83 / $6,456.54
| Facility | | $323.59 | $691.83 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $758.58 / $977.24
| Professional | | $707.95 | $758.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $8,128.31
| Facility | | $2,570.40 | $4,365.16 | $8,128.31 |