- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $7,079.46 / $11,481.54
| Facility | | $794.33 | $7,079.46 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,589.25 / $24,547.09
| Facility | | $9,772.37 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $870.96 / $9,772.37
| Facility | | $380.19 | $870.96 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $912.01 / $1,202.26
| Professional | | $851.14 | $912.01 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,079.46 / $9,120.11
| Facility | | $6,309.57 | $7,079.46 | $9,120.11 |