- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,090.30 / $6,760.83
| Facility | | $616.60 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $660.69 / $1,949.84
| Professional | | $346.74 | $660.69 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $812.83 / $8,317.64
| Facility | | $416.87 | $812.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $977.24 / $1,230.27
| Professional | | $758.58 | $977.24 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $15,488.17
| Facility | | $2,951.21 | $6,606.93 | $15,488.17 |