- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,290.87 / $6,025.60
| Facility | | $371.54 | $2,290.87 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $645.65 / $1,258.93
| Professional | | $208.93 | $645.65 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $676.08 / $2,951.21
| Facility | | $316.23 | $676.08 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $933.25 / $1,174.90
| Professional | | $524.81 | $933.25 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,630.78 / $6,309.57
| Facility | | $1,778.28 | $3,630.78 | $6,309.57 |