- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $3,235.94 / $6,760.83
| Facility | | $263.03 | $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
- $147.91 / $323.59 / $831.76
| Professional | | $147.91 | $323.59 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $407.38 / $4,897.79
| Facility | | $186.21 | $407.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $389.05 / $794.33
| Professional | | $338.84 | $389.05 | $794.33 |
- 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 |