- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $6,456.54 / $11,481.54
| Facility | | $691.83 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,244.36 / $14,125.38
| Facility | | $5,623.41 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $776.25 / $8,912.51
| Facility | | $338.84 | $776.25 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $794.33 / $1,047.13
| Professional | | $741.31 | $794.33 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $8,912.51
| Facility | | $4,466.84 | $5,495.41 | $8,912.51 |