- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,025.60 / $16,595.87
| Facility | | $616.60 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,786.30 / $8,912.51
| Facility | | $1,995.26 | $4,786.30 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $616.60 / $776.25
| Facility | | $501.19 | $616.60 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $1,288.25
| Professional | | $724.44 | $724.44 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $602.56 / $1,047.13
| Facility | | $380.19 | $602.56 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $11,220.18 / $16,982.44
| Facility | | $1,995.26 | $11,220.18 | $16,982.44 |