- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,096.48 / $6,606.93
| Facility | | $630.96 | $1,096.48 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $1,288.25
| Professional | | $831.76 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $1,047.13
| Facility | | $426.58 | $645.65 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $933.25
| Facility | | $602.56 | $831.76 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $645.65 / $977.24
| Facility | | $416.87 | $645.65 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,011.87 / $6,025.60
| Facility | | $3,801.89 | $5,011.87 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $4,365.16 / $6,918.31
| Facility | | $389.05 | $4,365.16 | $6,918.31 |