- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,981.07 / $7,762.47
| Facility | | $794.33 | $3,981.07 | $7,762.47 |
- 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
- $380.19 / $724.44 / $1,348.96
| Professional | | $380.19 | $724.44 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $891.25 / $5,754.40
| Facility | | $436.52 | $891.25 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,318.26
| Professional | | $758.58 | $1,071.52 | $1,318.26 |
- 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 |