- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $870.96 / $1,905.46
| Facility | | $512.86 | $870.96 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,584.89 / $2,511.89
| Facility | | $1,348.96 | $1,584.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,047.13 / $3,715.35
| Facility | | $512.86 | $1,047.13 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,174.90 / $8,317.64
| Facility | | $512.86 | $1,174.90 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,202.26 / $1,778.28
| Professional | | $602.56 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,943.28 / $7,943.28
| Facility | | $5,370.32 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |