- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $8,709.64 / $16,595.87
| Facility | | $363.08 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,897.79 / $8,912.51
| Facility | | $2,754.23 | $4,897.79 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $309.03 / $489.78
| Facility | | $204.17 | $309.03 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $13,182.57 / $23,442.29
| Facility | | $5,128.61 | $13,182.57 | $23,442.29 |