- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,290.87 / $6,606.93
| Facility | | $275.42 | $2,290.87 | $6,606.93 |
- 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
- $134.90 / $457.09 / $912.01
| Professional | | $134.90 | $457.09 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $446.68 / $4,570.88
| Facility | | $199.53 | $446.68 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $616.60 / $954.99
| Professional | | $269.15 | $616.60 | $954.99 |
- 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 |