- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $5,011.87 / $7,943.28
| Facility | | $562.34 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $812.83 / $1,862.09
| Professional | | $302.00 | $812.83 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $794.33 / $8,511.38
| Facility | | $371.54 | $794.33 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $870.96 / $954.99
| Professional | | $724.44 | $870.96 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,762.47 / $10,964.78
| Facility | | $3,715.35 | $7,762.47 | $10,964.78 |