- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $2,511.89 / $6,760.83
| Facility | | $141.25 | $2,511.89 | $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
- $83.18 / $1,230.27 / $2,238.72
| Professional | | $83.18 | $1,230.27 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $1,122.02 / $4,677.35
| Facility | | $102.33 | $1,122.02 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $1,698.24 / $2,344.23
| Professional | | $194.98 | $1,698.24 | $2,344.23 |
- 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 |