- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,344.23 / $6,918.31
| Facility | | $691.83 | $2,344.23 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $4,570.88
| Facility | | $3,235.94 | $3,235.94 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,621.81
| Professional | | $933.25 | $933.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $851.14 / $1,348.96
| Facility | | $691.83 | $851.14 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $14,791.08 / $22,908.68
| Facility | | $5,370.32 | $14,791.08 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $45,708.82
| Facility | | $19,952.62 | $19,952.62 | $45,708.82 |