- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $9,120.11 / $16,595.87
| Facility | | $954.99 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,715.35 / $6,760.83
| Facility | | $1,862.09 | $3,715.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Professional | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $870.96 / $1,288.25
| Facility | | $676.08 | $870.96 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,760.83 / $10,471.29
| Facility | | $1,698.24 | $6,760.83 | $10,471.29 |