- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,905.46 / $6,165.95
| Facility | | $562.34 | $1,905.46 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $537.03 / $602.56
| Facility | | $467.74 | $537.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $676.08 / $1,122.02
| Facility | | $338.84 | $676.08 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Professional | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $912.01
| Facility | | $389.05 | $562.34 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,778.28 / $5,888.44
| Facility | | $398.11 | $1,778.28 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $19,498.45
| Facility | | $3,715.35 | $3,715.35 | $19,498.45 |