- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $3,235.94 / $8,317.64
| Facility | | $169.82 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $158.49 / $194.98
| Professional | | $131.83 | $158.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $204.17 / $309.03
| Facility | | $144.54 | $204.17 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $204.17 / $8,709.64
| Facility | | $141.25 | $204.17 | $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 |