- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $5,128.61 / $7,943.28
| Facility | | $446.68 | $5,128.61 | $7,943.28 |
- 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
- $245.47 / $478.63 / $1,698.24
| Professional | | $245.47 | $478.63 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $616.60 / $13,489.63
| Facility | | $288.40 | $616.60 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $645.65 / $707.95
| Professional | | $501.19 | $645.65 | $707.95 |
- 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
- $3,715.35 / $8,511.38 / $15,848.93
| Facility | | $3,715.35 | $8,511.38 | $15,848.93 |