- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $7,943.28 / $13,803.84
| Facility | | $645.65 | $7,943.28 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,398.83
| Facility | | $2,041.74 | $2,041.74 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $489.78 / $630.96
| Professional | | $354.81 | $489.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $831.76
| Facility | | $251.19 | $380.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $524.81
| Facility | | $416.87 | $489.78 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $380.19 / $616.60
| Facility | | $239.88 | $380.19 | $616.60 |
- 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 |