- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,466.84 / $9,772.37
| Facility | | $676.08 | $4,466.84 | $9,772.37 |
- 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
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $467.74 / $549.54
| Professional | | $363.08 | $467.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $912.01
| Professional | | $524.81 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $512.86 / $794.33
| Facility | | $371.54 | $512.86 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $501.19 / $6,918.31
| Facility | | $371.54 | $501.19 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,079.46 / $13,803.84
| Facility | | $3,630.78 | $7,079.46 | $13,803.84 |