- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,801.89 / $8,511.38
| Facility | | $295.12 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,248.07 / $10,232.93
| Facility | | $3,981.07 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $323.59 / $9,549.93
| Facility | | $147.91 | $323.59 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $338.84 / $467.74
| Professional | | $331.13 | $338.84 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,897.79 / $8,128.31
| Facility | | $3,630.78 | $4,897.79 | $8,128.31 |