- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,128.31 / $12,302.69
| Facility | | $4,466.84 | $8,128.31 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $1,995.26 / $6,309.57
| Professional | | $169.82 | $1,995.26 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Professional | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $17,782.79 / $29,512.09
| Facility | | $11,748.98 | $17,782.79 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $8,709.64 / $21,379.62
| Facility | | $3,890.45 | $8,709.64 | $21,379.62 |