- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $10,232.93
| Facility | | $954.99 | $2,884.03 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,182.57 / $17,378.01
| Facility | | $7,943.28 | $13,182.57 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Facility | | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $870.96 / $12,022.64
| Professional | | $12.02 | $870.96 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,786.30 / $12,022.64
| Facility | | $2,951.21 | $4,786.30 | $12,022.64 |