- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.80 / $4,564.91 / $9,583.33
| Facility | | $627.80 | $4,564.91 | $9,583.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.51 / $702.11 / $856.09
| Professional | | $491.51 | $702.11 | $856.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.21 / $684.87 / $988.72
| Facility | | $519.21 | $684.87 | $988.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.22 / $661.93 / $5,122.00
| Facility | | $505.22 | $661.93 | $5,122.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,373.00 / $17,192.00
| Facility | | $6,303.00 | $9,373.00 | $17,192.00 |