- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,801.89 / $12,589.25
| Facility | | $794.33 | $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 / $331.13 / $758.58
| Facility | | $100.00 | $331.13 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $660.69 / $912.01
| Professional | | $223.87 | $660.69 | $912.01 |
- 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 |