- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,235.94 / $8,317.64
| Facility | | $407.38 | $3,235.94 | $8,317.64 |
- 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
- $302.00 / $380.19 / $457.09
| Professional | | $302.00 | $380.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $691.83 / $831.76
| Professional | | $562.34 | $691.83 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $758.58
| Facility | | $338.84 | $478.63 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $1,479.11
| Facility | | $338.84 | $478.63 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,202.26 / $2,454.71
| Facility | | $218.78 | $1,202.26 | $2,454.71 |