- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,862.09 / $5,011.87
| Facility | | $295.12 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $5,888.44
| Facility | | $3,388.44 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $891.25 / $933.25
| Facility | | $660.69 | $891.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $309.03 / $691.83
| Professional | | $89.13 | $309.03 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $691.83
| Facility | | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,949.84 / $6,309.57
| Facility | | $724.44 | $1,949.84 | $6,309.57 |