- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,511.89 / $6,760.83
| Facility | | $602.56 | $2,511.89 | $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
- $660.69 / $1,174.90 / $2,818.38
| Professional | | $660.69 | $1,174.90 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,548.82 / $8,912.51
| Facility | | $724.44 | $1,548.82 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $1,905.46
| Professional | | $1,202.26 | $1,584.89 | $1,905.46 |
- 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 |