- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,230.27 / $5,888.44
| Facility | | $537.03 | $1,230.27 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $676.08 / $812.83
| Professional | | $537.03 | $676.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,148.15
| Professional | | $602.56 | $758.58 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $954.99
| Facility | | $436.52 | $602.56 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $1,479.11
| Facility | | $407.38 | $575.44 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,148.15 / $2,398.83
| Facility | | $218.78 | $1,148.15 | $2,398.83 |