- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $7,244.36
| Facility | | $457.09 | $707.95 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $2,041.74
| Facility | | $1,548.82 | $1,819.70 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,818.38 / $4,897.79
| Facility | | $501.19 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $812.83
| Facility | | $354.81 | $512.86 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,466.84 / $9,549.93
| Facility | | $912.01 | $4,466.84 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $28,840.32
| Facility | | $16,595.87 | $16,595.87 | $28,840.32 |