- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $6,025.60 / $16,595.87
| Facility | | $562.34 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $5,128.61 / $10,232.93
| Facility | | $870.96 | $5,128.61 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $616.60 / $3,801.89
| Facility | | $501.19 | $616.60 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $660.69
| Professional | | $602.56 | $602.56 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $912.01
| Facility | | $389.05 | $549.54 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $10,232.93 / $17,378.01
| Facility | | $933.25 | $10,232.93 | $17,378.01 |