- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,786.30 / $8,317.64
| Facility | | $776.25 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- 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
- $645.65 / $812.83 / $954.99
| Professional | | $645.65 | $812.83 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,412.54 / $1,621.81
| Professional | | $1,122.02 | $1,412.54 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $912.01 / $1,479.11
| Facility | | $645.65 | $912.01 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $954.99 / $7,413.10
| Facility | | $676.08 | $954.99 | $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 |