- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,235.94 / $8,317.64
| Facility | | $676.08 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $13,182.57 / $15,488.17
| Facility | | $9,772.37 | $13,182.57 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $741.31
| Professional | | $489.78 | $630.96 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $954.99 / $1,348.96
| Professional | | $758.58 | $954.99 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,202.26
| Facility | | $549.54 | $758.58 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $741.31 / $1,548.82
| Facility | | $524.81 | $741.31 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,202.26 / $2,454.71
| Facility | | $218.78 | $1,202.26 | $2,454.71 |