- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,737.80 / $7,079.46
| Facility | | $660.69 | $1,737.80 | $7,079.46 |
- 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
- $575.44 / $724.44 / $851.14
| Professional | | $575.44 | $724.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $1,479.11
| Professional | | $912.01 | $1,148.15 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $1,318.26
| Facility | | $602.56 | $851.14 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $851.14 / $7,413.10
| Facility | | $616.60 | $851.14 | $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 |