- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,801.89 / $12,589.25
| Facility | | $537.03 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,949.84 / $3,801.89
| Facility | | $1,513.56 | $1,949.84 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $251.19 / $1,023.29
| Facility | | $95.50 | $251.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $416.87 / $524.81
| Professional | | $186.21 | $416.87 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,819.70 / $6,309.57
| Facility | | $870.96 | $1,819.70 | $6,309.57 |