- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $7,943.28 / $13,803.84
| Facility | | $302.00 | $7,943.28 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,698.24 / $3,311.31
| Facility | | $1,318.26 | $1,698.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $371.54 / $13,803.84
| Facility | | $181.97 | $371.54 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $371.54 / $501.19
| Professional | | $346.74 | $371.54 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,511.38 / $10,964.78
| Facility | | $6,918.31 | $8,511.38 | $10,964.78 |