- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,168.69 / $8,317.64
| Facility | | $933.25 | $4,168.69 | $8,317.64 |
- 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
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $616.60 / $724.44
| Professional | | $478.63 | $616.60 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,174.90 / $1,230.27
| Professional | | $954.99 | $1,174.90 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $691.83 / $1,122.02
| Facility | | $501.19 | $691.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $724.44 / $6,918.31
| Facility | | $501.19 | $724.44 | $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 |