- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,981.07 / $6,760.83
| Facility | | $741.31 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $851.14 / $1,819.70
| Professional | | $416.87 | $851.14 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,047.13 / $23,442.29
| Facility | | $524.81 | $1,047.13 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $1,318.26
| Professional | | $912.01 | $1,148.15 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $11,748.98 / $28,183.83
| Facility | | $4,677.35 | $11,748.98 | $28,183.83 |