- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $6,456.54 / $11,481.54
| Facility | | $316.23 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,370.32 / $10,471.29
| Facility | | $4,073.80 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $288.40 / $549.54
| Facility | | $154.88 | $288.40 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $741.31
| Professional | | $363.08 | $524.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,467.37 / $8,128.31
| Facility | | $2,630.27 | $3,467.37 | $8,128.31 |