- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,801.89 / $12,589.25
| Facility | | $562.34 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,073.80 / $7,943.28
| Facility | | $3,090.30 | $4,073.80 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $257.04 / $691.83
| Facility | | $100.00 | $257.04 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $478.63 / $660.69
| Professional | | $223.87 | $478.63 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $8,128.31
| Facility | | $2,398.83 | $3,162.28 | $8,128.31 |