- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,630.78 / $14,791.08
| Facility | | $446.68 | $3,630.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $354.81 / $436.52
| Professional | | $295.12 | $354.81 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $588.84 / $891.25
| Facility | | $363.08 | $588.84 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $562.34 / $7,413.10
| Facility | | $371.54 | $562.34 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |