- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,801.89 / $10,232.93
| Facility | | $912.01 | $3,801.89 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $794.33 / $1,819.70
| Professional | | $416.87 | $794.33 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,047.13 / $14,454.40
| Facility | | $467.74 | $1,047.13 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,096.48 / $1,202.26
| Professional | | $954.99 | $1,096.48 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | | $8,912.51 | $8,912.51 | $8,912.51 |
- 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 |