- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $5,370.32 / $9,120.11
| Facility | | $407.38 | $5,370.32 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $2,041.74
| Facility | | $1,548.82 | $1,819.70 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,621.81 / $2,691.53
| Facility | | $501.19 | $1,621.81 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $616.60
| Facility | | $288.40 | $389.05 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,890.45 / $9,549.93
| Facility | | $912.01 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $42,657.95
| Facility | | $7,943.28 | $7,943.28 | $42,657.95 |