- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,981.07 / $6,760.83
| Facility | | $724.44 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $741.31 / $1,737.80
| Professional | | $398.11 | $741.31 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $977.24 / $9,332.54
| Facility | | $436.52 | $977.24 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,023.29 / $1,148.15
| Professional | | $891.25 | $1,023.29 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | | $4,786.30 | $4,786.30 | $4,786.30 |
- 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 |