- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,778.28 / $7,585.78
| Facility | | $645.65 | $1,778.28 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $1,148.15
| Professional | | $741.31 | $741.31 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $616.60 / $912.01
| Facility | | $478.63 | $616.60 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,918.31 / $10,471.29
| Facility | | $2,187.76 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $8,912.51 / $8,912.51
| Facility | | $56.23 | $8,912.51 | $8,912.51 |