- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $2,570.40 / $6,760.83
| Facility | | $331.13 | $2,570.40 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $346.74 / $1,096.48
| Professional | | $186.21 | $346.74 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $436.52 / $6,760.83
| Facility | | $177.83 | $436.52 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $467.74 / $524.81
| Professional | | $389.05 | $467.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $7,762.47
| Facility | | $2,570.40 | $5,128.61 | $7,762.47 |