- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $3,548.13 / $10,964.78
| Facility | | $186.21 | $3,548.13 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,951.21 / $5,754.40
| Facility | | $2,238.72 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $208.93 / $3,467.37
| Facility | | $91.20 | $208.93 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $229.09 / $295.12
| Professional | | $204.17 | $229.09 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,819.70 / $6,309.57
| Facility | | $870.96 | $1,819.70 | $6,309.57 |