- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,981.07 / $9,332.54
| Facility | | $891.25 | $3,981.07 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $1,380.38
| Professional | | $707.95 | $707.95 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $676.08 / $1,047.13
| Facility | | $363.08 | $676.08 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $9,549.93 / $14,454.40
| Facility | | $3,311.31 | $9,549.93 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,840.32
| Facility | | $28,183.83 | $28,183.83 | $28,840.32 |