- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $6,456.54 / $11,481.54
| Facility | | $371.54 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,466.84 / $8,709.64
| Facility | | $3,388.44 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $4,786.30
| Facility | | $234.42 | $407.38 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $630.96 / $812.83
| Professional | | $363.08 | $630.96 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,365.16 / $8,128.31
| Facility | | $3,630.78 | $4,365.16 | $8,128.31 |