- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $6,025.60 / $16,595.87
| Facility | | $512.86 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,025.60 / $10,964.78
| Facility | | $2,344.23 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $501.19 / $2,570.40
| Facility | | $467.74 | $501.19 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $1,071.52
| Professional | | $630.96 | $630.96 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $478.63 / $870.96
| Facility | | $245.47 | $478.63 | $870.96 |
- 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 |