- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,630.78 / $7,943.28
| Facility | | $446.68 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $398.11 / $467.74
| Professional | | $309.03 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $524.81 / $758.58
| Professional | | $426.58 | $524.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $660.69
| Facility | | $309.03 | $426.58 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $416.87 / $6,918.31
| Facility | | $309.03 | $416.87 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,079.46 / $13,803.84
| Facility | | $3,630.78 | $7,079.46 | $13,803.84 |