- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,235.94 / $6,760.83
| Facility | | $645.65 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Facility | | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $676.08 / $1,479.11
| Professional | | $354.81 | $676.08 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $891.25 / $13,489.63
| Facility | | $446.68 | $891.25 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $933.25 / $1,023.29
| Professional | | $707.95 | $933.25 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Facility | | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $15,848.93
| Facility | | $2,951.21 | $6,606.93 | $15,848.93 |