- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,630.78 / $9,549.93
| Facility | | $977.24 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,471.29 / $14,454.40
| Facility | | $6,606.93 | $10,471.29 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,122.02 / $1,348.96
| Professional | | $870.96 | $1,122.02 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,412.54 / $2,187.76
| Professional | | $1,122.02 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $1,862.09
| Facility | | $891.25 | $1,202.26 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $4,073.80
| Facility | | $851.14 | $1,148.15 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,388.44 / $7,079.46
| Facility | | $1,584.89 | $3,388.44 | $7,079.46 |