- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,041.74 / $10,471.29
| Facility | | $794.33 | $2,041.74 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,230.27
| Professional | | $977.24 | $977.24 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $724.44 / $1,148.15
| Facility | | $524.81 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $9,549.93 / $14,454.40
| Facility | | $2,691.53 | $9,549.93 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,311.31 / $3,311.31
| Facility | | $56.23 | $3,311.31 | $3,311.31 |