- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,511.89 / $7,762.47
| Facility | | $676.08 | $2,511.89 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,621.81 / $4,365.16
| Professional | | $354.81 | $1,621.81 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,762.47 / $10,964.78
| Facility | | $4,570.88 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,760.83
| Facility | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $1,202.26
| Facility | | $489.78 | $676.08 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Professional | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,677.35 / $11,748.98
| Facility | | $1,148.15 | $4,677.35 | $11,748.98 |