- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,122.02 / $7,943.28
| Facility | | $851.14 | $1,122.02 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $812.83 / $933.25
| Professional | | $407.38 | $812.83 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $1,023.29
| Facility | | $436.52 | $660.69 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $741.31 / $851.14
| Facility | | $537.03 | $741.31 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $660.69 / $1,023.29
| Facility | | $416.87 | $660.69 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,413.10 / $8,912.51
| Facility | | $5,754.40 | $7,413.10 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,754.40 / $10,000.00
| Facility | | $1,698.24 | $5,754.40 | $10,000.00 |