- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $10,471.29 / $30,902.95
| Facility | | $954.99 | $10,471.29 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $630.96 / $1,380.38
| Professional | | $575.44 | $630.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $19,952.62 / $27,542.29
| Facility | | $8,317.64 | $19,952.62 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,318.26
| Professional | | $588.84 | $812.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $630.96 / $724.44
| Facility | | $575.44 | $630.96 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $812.83 / $1,380.38
| Professional | | $616.60 | $812.83 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,549.93 / $16,218.10
| Facility | | $4,466.84 | $9,549.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $707.95 / $1,258.93
| Professional | | $537.03 | $707.95 | $1,258.93 |