- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $2,511.89 / $6,760.83
| Facility | | $154.88 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $426.58 / $741.31
| Professional | | $91.20 | $426.58 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $416.87 / $2,238.72
| Facility | | $131.83 | $416.87 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $467.74 / $831.76
| Professional | | $218.78 | $467.74 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,818.38 / $4,897.79
| Facility | | $1,318.26 | $2,818.38 | $4,897.79 |