- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,265.80 / $12,589.25
| Facility | | $2,041.74 | $4,265.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $6,760.83
| Facility | | $2,630.27 | $3,311.31 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.70 / $151.36 / $346.74
| Facility | | $53.70 | $151.36 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $51.29 / $51.29 / $51.29
| Facility | 53 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $223.87 / $426.58
| Professional | | $83.18 | $223.87 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $6,456.54
| Facility | | $1,202.26 | $1,819.70 | $6,456.54 |