- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,570.40 / $6,760.83
| Facility | | $707.95 | $2,570.40 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $691.83 / $1,479.11
| Professional | | $398.11 | $691.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $912.01 / $3,630.78
| Facility | | $416.87 | $912.01 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $1,122.02
| Professional | | $660.69 | $977.24 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,630.78 / $6,309.57
| Facility | | $1,778.28 | $3,630.78 | $6,309.57 |