- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $6,025.60 / $10,964.78
| Facility | | $1,202.26 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,174.90 / $2,290.87
| Facility | | $891.25 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $691.83 / $1,778.28
| Facility | | $416.87 | $691.83 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,659.59
| Professional | | $758.58 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,511.89 / $6,309.57
| Facility | | $1,548.82 | $2,511.89 | $6,309.57 |