- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $3,235.94 / $7,244.36
| Facility | | $199.53 | $3,235.94 | $7,244.36 |
- 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 / $977.24 / $1,202.26
| Professional | | $131.83 | $977.24 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $870.96 / $1,047.13
| Professional | | $851.14 | $870.96 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $616.60 / $1,348.96
| Facility | | $165.96 | $616.60 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $263.03 / $8,709.64
| Facility | | $151.36 | $263.03 | $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 |