- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $3,630.78 / $9,549.93
| Facility | | $190.55 | $3,630.78 | $9,549.93 |
- 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
- $154.88 / $190.55 / $489.78
| Professional | | $154.88 | $190.55 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $416.87
| Professional | | $245.47 | $302.00 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $251.19 / $371.54
| Facility | | $177.83 | $251.19 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $239.88 / $5,248.07
| Facility | | $169.82 | $239.88 | $5,248.07 |
- 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 |