- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,801.89 / $12,589.25
| Facility | | $977.24 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,332.54 / $18,197.01
| Facility | | $7,244.36 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $1,023.29
| Facility | | $323.59 | $562.34 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $1,288.25
| Professional | | $758.58 | $1,023.29 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,456.54 / $8,317.64
| Facility | | $3,715.35 | $6,456.54 | $8,317.64 |