- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $3,090.30 / $6,760.83
| Facility | | $380.19 | $3,090.30 | $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
- $208.93 / $389.05 / $912.01
| Professional | | $208.93 | $389.05 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $537.03 / $5,011.87
| Facility | | $229.09 | $537.03 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $537.03 / $602.56
| Professional | | $457.09 | $537.03 | $602.56 |
- 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 |