- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $3,467.37 / $8,317.64
| Facility | | $223.87 | $3,467.37 | $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
- $158.49 / $199.53 / $489.78
| Professional | | $158.49 | $199.53 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $426.58
| Professional | | $251.19 | $316.23 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $251.19 / $398.11
| Facility | | $162.18 | $251.19 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $8,709.64
| Facility | | $173.78 | $245.47 | $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 |