- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $3,235.94 / $6,760.83
| Facility | | $331.13 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $346.74 / $776.25
| Professional | | $181.97 | $346.74 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $446.68 / $5,128.61
| Facility | | $199.53 | $446.68 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $457.09 / $524.81
| Professional | | $389.05 | $457.09 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,786.30 / $6,309.57
| Facility | | $2,511.89 | $4,786.30 | $6,309.57 |