- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $8,912.51 / $18,197.01
| Facility | | $691.83 | $8,912.51 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $8,912.51 / $16,982.44
| Facility | | $2,754.23 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $912.01 / $3,801.89
| Facility | | $562.34 | $912.01 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $870.96
| Professional | | $741.31 | $741.31 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $758.58 / $1,202.26
| Facility | | $537.03 | $758.58 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $16,982.44 / $25,703.96
| Facility | | $1,698.24 | $16,982.44 | $25,703.96 |