- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $6,025.60 / $9,772.37
| Facility | | $676.08 | $6,025.60 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $6,760.83 / $12,589.25
| Facility | | $1,258.93 | $6,760.83 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $8,128.31
| Facility | | $501.19 | $776.25 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $1,380.38
| Professional | | $707.95 | $707.95 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $707.95 / $1,288.25
| Facility | | $338.84 | $707.95 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,988.33
| Facility | | $2,344.23 | $13,182.57 | $23,988.33 |