- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $1,862.09 / $5,011.87
| Facility | | $194.98 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,467.37 / $4,466.84
| Facility | | $1,513.56 | $3,467.37 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $213.80 / $218.78
| Facility | | $154.88 | $213.80 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $158.49 / $288.40
| Professional | | $50.12 | $158.49 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,513.56 / $4,786.30
| Facility | | $407.38 | $1,513.56 | $4,786.30 |