- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,862.09 / $5,011.87
| Facility | | $549.54 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $5,888.44
| Facility | | $3,388.44 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,000.00 / $1,047.13
| Facility | | $741.31 | $1,000.00 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $489.78 / $851.14
| Professional | | $181.97 | $489.78 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,949.84 / $6,309.57
| Facility | | $724.44 | $1,949.84 | $6,309.57 |