- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $7,762.47 / $9,772.37
| Facility | | $1,288.25 | $7,762.47 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,677.35 / $9,772.37
| Facility | | $933.25 | $4,677.35 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $831.76 / $1,862.09
| Facility | | $501.19 | $831.76 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $616.60
| Professional | | $537.03 | $537.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $1,023.29
| Facility | | $457.09 | $616.60 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,471.29
| Facility | | $616.60 | $6,309.57 | $10,471.29 |