- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $3,630.78 / $9,549.93
| Facility | | $177.83 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,265.80 / $5,888.44
| Facility | | $2,951.21 | $4,265.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $147.91 / $181.97
| Professional | | $123.03 | $147.91 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $302.00 / $338.84
| Professional | | $234.42 | $302.00 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $223.87 / $331.13
| Facility | | $144.54 | $223.87 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $213.80 / $7,413.10
| Facility | | $138.04 | $213.80 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |