- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,096.48 / $7,585.78
| Facility | | $316.23 | $1,096.48 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,715.35
| Facility | | $3,630.78 | $3,630.78 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $776.25
| Professional | | $489.78 | $489.78 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $389.05 / $602.56
| Facility | | $302.00 | $389.05 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $21,379.62 / $28,840.32
| Facility | | $9,549.93 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $77,624.71 / $77,624.71
| Facility | | $19,498.45 | $77,624.71 | $77,624.71 |