- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,467.37 / $8,912.51
| Facility | | $870.96 | $3,467.37 | $8,912.51 |
- 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
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $831.76 / $977.24
| Professional | | $645.65 | $831.76 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $1,621.81
| Professional | | $912.01 | $1,148.15 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $1,412.54
| Facility | | $660.69 | $912.01 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $891.25 / $7,413.10
| Facility | | $630.96 | $891.25 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |