- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $4,897.79 / $9,120.11
| Facility | | $363.08 | $4,897.79 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $213.80 / $537.03
| Professional | | $173.78 | $213.80 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $380.19 / $478.63
| Professional | | $309.03 | $380.19 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $457.09
| Facility | | $204.17 | $295.12 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $288.40 / $8,709.64
| Facility | | $199.53 | $288.40 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |