- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,128.61 / $7,943.28
| Facility | | $776.25 | $5,128.61 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $7,413.10
| Facility | | $2,290.87 | $2,290.87 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $707.95 / $912.01
| Professional | | $524.81 | $707.95 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $977.24
| Facility | | $380.19 | $575.44 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $758.58 / $776.25
| Facility | | $630.96 | $758.58 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $575.44 / $954.99
| Facility | | $363.08 | $575.44 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $14,454.40 / $21,877.62
| Facility | | $8,511.38 | $14,454.40 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $9,549.93 / $22,908.68
| Facility | | $1,621.81 | $9,549.93 | $22,908.68 |