- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $6,025.60 / $16,595.87
| Facility | | $562.34 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,897.79 / $9,120.11
| Facility | | $2,137.96 | $4,897.79 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $645.65 / $1,148.15
| Facility | | $501.19 | $645.65 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $1,122.02
| Professional | | $630.96 | $630.96 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $549.54 / $954.99
| Facility | | $380.19 | $549.54 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,471.29 / $16,982.44
| Facility | | $1,995.26 | $10,471.29 | $16,982.44 |