- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $5,128.61 / $9,549.93
| Facility | | $208.93 | $5,128.61 | $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
- $158.49 / $194.98 / $489.78
| Professional | | $158.49 | $194.98 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $416.87 / $446.68
| Professional | | $354.81 | $416.87 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $288.40 / $489.78
| Facility | | $177.83 | $288.40 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $323.59 / $8,709.64
| Facility | | $177.83 | $323.59 | $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 |