- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $5,888.44 / $10,964.78
| Facility | | $645.65 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $758.58
| Professional | | $512.86 | $645.65 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,318.26
| Professional | | $602.56 | $758.58 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $1,122.02
| Facility | | $537.03 | $724.44 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $691.83 / $9,549.93
| Facility | | $489.78 | $691.83 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,220.18 / $23,988.33
| Facility | | $6,456.54 | $11,220.18 | $23,988.33 |