- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $7,943.28 / $16,595.87
| Facility | | $758.58 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $23,442.29 / $44,668.36
| Facility | | $2,238.72 | $23,442.29 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,148.15
| Facility | | $891.25 | $891.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,548.82
| Professional | | $1,148.15 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $1,548.82
| Facility | | $660.69 | $912.01 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $21,877.62 / $33,113.11
| Facility | | $8,317.64 | $21,877.62 | $33,113.11 |