- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $8,709.64 / $16,595.87
| Facility | | $645.65 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $10,715.19
| Facility | | $2,691.53 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $707.95 / $2,570.40
| Facility | | $575.44 | $707.95 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $1,348.96
| Professional | | $616.60 | $616.60 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $616.60 / $1,096.48
| Facility | | $398.11 | $616.60 | $1,096.48 |
- 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 |