- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,570.40 / $6,760.83
| Facility | | $281.84 | $2,570.40 | $6,760.83 |
- 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
- $154.88 / $407.38 / $891.25
| Professional | | $154.88 | $407.38 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $416.87 / $3,630.78
| Facility | | $204.17 | $416.87 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $416.87 / $478.63
| Professional | | $363.08 | $416.87 | $478.63 |
- 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 |