- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,235.94 / $7,244.36
| Facility | | $616.60 | $3,235.94 | $7,244.36 |
- 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
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $812.83 / $954.99
| Professional | | $630.96 | $812.83 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $891.25 / $1,445.44
| Professional | | $707.95 | $891.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $676.08 / $1,096.48
| Facility | | $436.52 | $676.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $6,918.31
| Facility | | $398.11 | $537.03 | $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 |