- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $4,073.80 / $7,943.28
| Facility | | $269.15 | $4,073.80 | $7,943.28 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $501.19
| Professional | | $331.13 | $416.87 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $724.44
| Professional | | $316.23 | $398.11 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $295.12 / $512.86
| Facility | | $158.49 | $295.12 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $194.98 / $3,388.44
| Facility | | $138.04 | $194.98 | $3,388.44 |
- 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 |