- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,630.78 / $9,549.93
| Facility | | $933.25 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $19,054.61 / $26,302.68
| Facility | | $11,748.98 | $19,054.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $2,344.23
| Professional | | $741.31 | $933.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,122.02 / $1,819.70
| Professional | | $891.25 | $1,122.02 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $1,698.24
| Facility | | $851.14 | $1,071.52 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $5,248.07
| Facility | | $707.95 | $1,023.29 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |