- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $3,630.78 / $9,549.93
| Facility | | $181.97 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,232.93 / $14,125.38
| Facility | | $6,760.83 | $10,232.93 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $154.88 / $190.55
| Professional | | $128.82 | $154.88 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $302.00 / $346.74
| Professional | | $239.88 | $302.00 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $229.09 / $338.84
| Facility | | $147.91 | $229.09 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $213.80 / $7,413.10
| Facility | | $141.25 | $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 |