- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,235.94 / $7,244.36
| Facility | | $645.65 | $3,235.94 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $446.68 / $524.81
| Professional | | $346.74 | $446.68 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $707.95 / $831.76
| Professional | | $575.44 | $707.95 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $741.31
| Facility | | $346.74 | $467.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $6,918.31
| Facility | | $346.74 | $489.78 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,079.46 / $14,125.38
| Facility | | $3,715.35 | $7,079.46 | $14,125.38 |