- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $4,365.16 / $9,772.37
| Facility | | $389.05 | $4,365.16 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,918.31 / $13,182.57
| Facility | | $2,630.27 | $6,918.31 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $512.86 / $3,162.28
| Facility | | $371.54 | $512.86 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $870.96
| Professional | | $630.96 | $630.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $831.76
| Facility | | $363.08 | $501.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,442.29
| Facility | | $2,344.23 | $13,182.57 | $23,442.29 |