- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $7,943.28
| Facility | | $912.01 | $1,202.26 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $912.01 / $1,202.26
| Professional | | $707.95 | $912.01 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $812.83 / $1,412.54
| Facility | | $478.63 | $812.83 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $891.25 / $954.99
| Facility | | $660.69 | $891.25 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,096.48
| Facility | | $467.74 | $660.69 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $12,022.64 / $14,125.38
| Facility | | $8,511.38 | $12,022.64 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,232.93 / $16,982.44
| Facility | | $1,995.26 | $10,232.93 | $16,982.44 |