- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,981.07 / $6,760.83
| Facility | | $1,096.48 | $3,981.07 | $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
- $602.56 / $1,047.13 / $1,862.09
| Professional | | $602.56 | $1,047.13 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,445.44 / $7,079.46
| Facility | | $676.08 | $1,445.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $1,778.28
| Professional | | $1,047.13 | $1,513.56 | $1,778.28 |
- 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
- $2,951.21 / $6,025.60 / $8,511.38
| Facility | | $2,951.21 | $6,025.60 | $8,511.38 |