- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $6,456.54 / $10,471.29
| Facility | | $398.11 | $6,456.54 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,778.28 / $3,715.35
| Professional | | $489.78 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $10,471.29 / $34,673.69
| Facility | | $1,148.15 | $10,471.29 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,621.81 / $3,630.78
| Professional | | $1,096.48 | $1,621.81 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $16,218.10 / $33,884.42
| Facility | | $9,549.93 | $16,218.10 | $33,884.42 |