- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,467.37 / $5,011.87
| Facility | | $758.58 | $3,467.37 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,332.54 / $10,964.78
| Facility | | $4,466.84 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $16,982.44 / $17,782.79
| Facility | | $3,019.95 | $16,982.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $416.87 / $3,890.45
| Professional | | $7.94 | $416.87 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,548.13 / $10,715.19
| Facility | | $1,258.93 | $3,548.13 | $10,715.19 |