- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,511.89 / $6,760.83
| Facility | | $575.44 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $630.96 / $1,148.15
| Professional | | $323.59 | $630.96 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $794.33 / $5,623.41
| Facility | | $407.38 | $794.33 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $933.25 / $1,202.26
| Professional | | $724.44 | $933.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,248.07 / $8,709.64
| Facility | | $2,570.40 | $5,248.07 | $8,709.64 |