- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $5,495.41 / $10,471.29
| Facility | | $588.84 | $5,495.41 | $10,471.29 |
- 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
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $741.31
| Professional | | $489.78 | $630.96 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $1,230.27
| Professional | | $616.60 | $776.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $1,047.13
| Facility | | $489.78 | $676.08 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $6,918.31
| Facility | | $467.74 | $660.69 | $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 |