- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $9,772.37 / $19,498.45
| Facility | | $1,380.38 | $9,772.37 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,165.95 / $12,022.64
| Facility | | $3,090.30 | $6,165.95 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $870.96 / $2,570.40
| Facility | | $575.44 | $870.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $1,202.26
| Professional | | $870.96 | $870.96 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $691.83 / $1,202.26
| Facility | | $501.19 | $691.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $13,182.57 / $23,442.29
| Facility | | $2,511.89 | $13,182.57 | $23,442.29 |