- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $3,090.30 / $6,760.83
| Facility | | $275.42 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $707.95 / $1,000.00
| Professional | | $154.88 | $707.95 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $660.69 / $4,570.88
| Facility | | $234.42 | $660.69 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $758.58 / $1,445.44
| Professional | | $346.74 | $758.58 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,786.30 / $6,309.57
| Facility | | $2,511.89 | $4,786.30 | $6,309.57 |