- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $4,786.30 / $7,079.46
| Facility | | $891.25 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $933.25 / $1,698.24
| Professional | | $489.78 | $933.25 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,148.15 / $7,079.46
| Facility | | $549.54 | $1,148.15 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,202.26 / $1,412.54
| Professional | | $851.14 | $1,202.26 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,025.60 / $8,511.38
| Facility | | $2,951.21 | $6,025.60 | $8,511.38 |