- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,388.44 / $6,760.83
| Facility | | $812.83 | $3,388.44 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $851.14 / $1,659.59
| Professional | | $457.09 | $851.14 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,071.52 / $6,606.93
| Facility | | $489.78 | $1,071.52 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,096.48 / $1,288.25
| Professional | | $724.44 | $1,096.48 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $7,762.47
| Facility | | $2,570.40 | $5,128.61 | $7,762.47 |