- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,818.38 / $7,079.46
| Facility | | $549.54 | $2,818.38 | $7,079.46 |
- 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
- $524.81 / $676.08 / $794.33
| Professional | | $524.81 | $676.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $1,230.27
| Professional | | $562.34 | $707.95 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $933.25
| Facility | | $363.08 | $562.34 | $933.25 |
- 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 |