- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,754.23 / $7,943.28
| Facility | | $630.96 | $2,754.23 | $7,943.28 |
- 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
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $758.58 / $891.25
| Professional | | $588.84 | $758.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $1,380.38
| Professional | | $741.31 | $933.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $1,122.02
| Facility | | $446.68 | $691.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $6,918.31
| Facility | | $416.87 | $562.34 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,244.36 / $14,125.38
| Facility | | $3,801.89 | $7,244.36 | $14,125.38 |