- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $6,025.60 / $13,803.84
| Facility | | $457.09 | $6,025.60 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,890.45 / $8,317.64
| Facility | | $1,659.59 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $812.83 / $2,290.87
| Facility | | $512.86 | $812.83 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $501.19
| Professional | | $467.74 | $467.74 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $660.69
| Facility | | $302.00 | $436.52 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $10,232.93 / $16,982.44
| Facility | | $933.25 | $10,232.93 | $16,982.44 |