- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $7,943.28
| Facility | | $602.56 | $758.58 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $707.95
| Professional | | $407.38 | $549.54 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $380.19 / $758.58
| Facility | | $281.84 | $380.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $588.84 / $602.56
| Facility | | $489.78 | $588.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $407.38 / $724.44
| Facility | | $269.15 | $407.38 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,715.35 / $4,466.84
| Facility | | $2,818.38 | $3,715.35 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,897.79 / $7,244.36
| Facility | | $1,548.82 | $4,897.79 | $7,244.36 |