- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.62 / $4,235.59 / $7,119.04
| Facility | | $820.62 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $953.00 / $953.00
| Facility | | $953.00 | $953.00 | $953.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.21 / $580.04 / $1,174.61
| Professional | | $223.21 | $580.04 | $1,174.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.88 / $784.48 / $2,222.48
| Facility | | $396.88 | $784.48 | $2,222.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.09 / $949.44 / $1,197.21
| Facility | | $513.09 | $949.44 | $1,197.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $4,663.00 / $7,305.00
| Facility | | $1,770.00 | $4,663.00 | $7,305.00 |