- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $2,570.40 / $7,943.28
| Facility | | $257.04 | $2,570.40 | $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
- $144.54 / $269.15 / $741.31
| Professional | | $144.54 | $269.15 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $363.08 / $14,454.40
| Facility | | $154.88 | $363.08 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $363.08 / $407.38
| Professional | | $323.59 | $363.08 | $407.38 |
- 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
- $2,570.40 / $5,495.41 / $15,848.93
| Facility | | $2,570.40 | $5,495.41 | $15,848.93 |