- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $5,888.44 / $16,595.87
| Facility | | $537.03 | $5,888.44 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,570.88 / $8,912.51
| Facility | | $2,187.76 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,344.23 / $2,570.40
| Facility | | $741.31 | $2,344.23 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $1,548.82
| Professional | | $741.31 | $741.31 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $676.08 / $1,202.26
| Facility | | $426.58 | $676.08 | $1,202.26 |
- 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 |