- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $4,570.88 / $7,079.46
| Facility | | $194.98 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $407.38 / $870.96
| Professional | | $218.78 | $407.38 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $512.86 / $7,943.28
| Facility | | $251.19 | $512.86 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $512.86 / $630.96
| Professional | | $407.38 | $512.86 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,309.57 / $8,912.51
| Facility | | $2,951.21 | $6,309.57 | $8,912.51 |