- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $9,549.93 / $15,848.93
| Facility | | $707.95 | $9,549.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,398.83
| Facility | | $2,344.23 | $2,344.23 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $741.31
| Professional | | $416.87 | $562.34 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $912.01
| Facility | | $302.00 | $457.09 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $616.60
| Facility | | $489.78 | $575.44 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $457.09 / $724.44
| Facility | | $281.84 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,232.93 / $12,022.64
| Facility | | $7,413.10 | $10,232.93 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $9,549.93 / $12,882.50
| Facility | | $1,621.81 | $9,549.93 | $12,882.50 |