- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $4,073.80 / $14,791.08
| Facility | | $575.44 | $4,073.80 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,786.30 / $8,912.51
| Facility | | $2,344.23 | $4,786.30 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,122.02 / $1,737.80
| Facility | | $851.14 | $1,122.02 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,584.89
| Professional | | $831.76 | $831.76 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $741.31 / $1,318.26
| Facility | | $501.19 | $741.31 | $1,318.26 |
- 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 |