- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $5,248.07 / $14,791.08
| Facility | | $870.96 | $5,248.07 | $14,791.08 |
- 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
- $457.09 / $575.44 / $691.83
| Professional | | $457.09 | $575.44 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $891.25 / $1,148.15
| Professional | | $707.95 | $891.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $1,071.52
| Facility | | $478.63 | $660.69 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $660.69 / $7,413.10
| Facility | | $489.78 | $660.69 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |