- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,801.89 / $12,589.25
| Facility | | $707.95 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $7,762.47 / $15,135.61
| Facility | | $5,888.44 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $354.81 / $5,128.61
| Facility | | $154.88 | $354.81 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $549.54 / $724.44
| Professional | | $288.40 | $549.54 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,495.41 / $8,912.51
| Facility | | $4,365.16 | $5,495.41 | $8,912.51 |