- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,801.89 / $6,760.83
| Facility | | $537.03 | $3,801.89 | $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
- $245.47 / $467.74 / $1,096.48
| Professional | | $245.47 | $467.74 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $616.60 / $5,011.87
| Facility | | $269.15 | $616.60 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $616.60 / $707.95
| Professional | | $512.86 | $616.60 | $707.95 |
- 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 |