- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $3,090.30 / $6,760.83
| Facility | | $426.58 | $3,090.30 | $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
- $234.42 / $512.86 / $1,230.27
| Professional | | $234.42 | $512.86 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $630.96 / $3,630.78
| Facility | | $281.84 | $630.96 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $630.96 / $707.95
| Professional | | $524.81 | $630.96 | $707.95 |
- 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 |