- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,023.29 / $2,754.23
| Facility | | $181.97 | $1,023.29 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $1,584.89
| Facility | | $1,202.26 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,454.71 / $3,890.45
| Facility | | $2,089.30 | $2,454.71 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,548.82 / $3,801.89
| Facility | | $181.97 | $1,548.82 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,202.26 / $1,778.28
| Facility | | $181.97 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $831.76 / $2,570.40
| Professional | | $295.12 | $831.76 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $8,709.64 / $8,709.64
| Facility | | $371.54 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,137.96
| Facility | | $1,023.29 | $1,584.89 | $2,137.96 |