- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,698.24 / $10,471.29
| Facility | | $426.58 | $1,698.24 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $776.25
| Professional | | $501.19 | $501.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $724.44
| Facility | | $331.13 | $426.58 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,467.37 / $6,606.93
| Facility | | $1,230.27 | $3,467.37 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $33,884.42
| Facility | | $8,912.51 | $8,912.51 | $33,884.42 |