- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,801.89 / $13,182.57
| Facility | | $676.08 | $3,801.89 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,248.07 / $7,079.46
| Facility | | $3,467.37 | $5,248.07 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,995.26
| Professional | | $602.56 | $758.58 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $851.14 / $1,412.54
| Professional | | $676.08 | $851.14 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $794.33 / $1,258.93
| Facility | | $616.60 | $794.33 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $3,630.78
| Facility | | $549.54 | $812.83 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,311.31 / $5,754.40
| Facility | | $1,737.80 | $3,311.31 | $5,754.40 |