- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,090.30 / $6,760.83
| Facility | | $323.59 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $912.01 / $1,288.25
| Professional | | $181.97 | $912.01 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,023.29 / $7,079.46
| Facility | | $275.42 | $1,023.29 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,380.38 / $1,905.46
| Professional | | $467.74 | $1,380.38 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,309.57 / $10,232.93
| Facility | | $2,951.21 | $6,309.57 | $10,232.93 |