- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $4,897.79 / $8,317.64
| Facility | | $389.05 | $4,897.79 | $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
- $316.23 / $398.11 / $467.74
| Professional | | $316.23 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $776.25
| Professional | | $512.86 | $645.65 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $724.44
| Facility | | $323.59 | $446.68 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $467.74 / $6,918.31
| Facility | | $338.84 | $467.74 | $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 |