- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $4,786.30 / $8,317.64
| Facility | | $724.44 | $4,786.30 | $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
- $630.96 / $776.25 / $933.25
| Professional | | $630.96 | $776.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $977.24 / $1,621.81
| Professional | | $776.25 | $977.24 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $933.25 / $1,380.38
| Facility | | $660.69 | $933.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $6,918.31
| Facility | | $630.96 | $912.01 | $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 |