- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,715.35 / $9,772.37
| Facility | | $467.74 | $3,715.35 | $9,772.37 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $2,290.87
| Facility | | $549.54 | $549.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $562.34 / $660.69
| Professional | | $426.58 | $562.34 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $645.65
| Professional | | $562.34 | $562.34 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $676.08
| Facility | | $302.00 | $436.52 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $5,011.87
| Facility | | $281.84 | $426.58 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,467.37 / $5,754.40
| Facility | | $1,737.80 | $3,467.37 | $5,754.40 |