- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,365.16 / $8,317.64
| Facility | | $616.60 | $4,365.16 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,819.70
| Facility | | $1,778.28 | $1,778.28 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $954.99
| Professional | | $691.83 | $691.83 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $489.78 / $776.25
| Facility | | $407.38 | $489.78 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,918.31 / $10,471.29
| Facility | | $2,137.96 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $6,760.83 / $6,760.83
| Facility | | $56.23 | $6,760.83 | $6,760.83 |