- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,235.94 / $6,760.83
| Facility | | $389.05 | $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
- $213.80 / $407.38 / $954.99
| Professional | | $213.80 | $407.38 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $549.54 / $5,011.87
| Facility | | $234.42 | $549.54 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $549.54 / $616.60
| Professional | | $478.63 | $549.54 | $616.60 |
- 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 |