- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.53 / $1,664.55 / $4,734.59
| Facility | | $757.53 | $1,664.55 | $4,734.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.63 / $1,309.32 / $3,367.85
| Facility | | $1,112.63 | $1,309.32 | $3,367.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.36 / $439.64 / $439.64
| Professional | | $180.36 | $439.64 | $439.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.32 / $2,473.07 / $2,967.13
| Facility | | $1,221.32 | $2,473.07 | $2,967.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.37 / $981.68 / $2,228.03
| Professional | | $676.37 | $981.68 | $2,228.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.55 / $405.82 / $405.82
| Professional | | $270.55 | $405.82 | $405.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.05 / $555.55 / $707.07
| Professional | | $505.05 | $555.55 | $707.07 |