- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,570.40 / $10,471.29
| Facility | | $954.99 | $2,570.40 | $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
- $1,288.25 / $1,288.25 / $1,737.80
| Professional | | $1,288.25 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,513.56
| Facility | | $724.44 | $954.99 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $9,332.54 / $14,454.40
| Facility | | $2,454.71 | $9,332.54 | $14,454.40 |
- 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 |