- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $5,011.87 / $12,589.25
| Facility | | $575.44 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,912.51 / $17,378.01
| Facility | | $6,760.83 | $8,912.51 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $380.19 / $3,090.30
| Facility | | $213.80 | $380.19 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $549.54 / $724.44
| Professional | | $436.52 | $549.54 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $4,570.88
| Facility | | $1,096.48 | $1,548.82 | $4,570.88 |