- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,570.40 / $7,079.46
| Facility | | $338.84 | $2,570.40 | $7,079.46 |
- 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
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $229.09 / $269.15
| Professional | | $177.83 | $229.09 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $323.59 / $457.09
| Professional | | $263.03 | $323.59 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $251.19 / $398.11
| Facility | | $186.21 | $251.19 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $251.19 / $3,162.28
| Facility | | $181.97 | $251.19 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,311.31 / $5,754.40
| Facility | | $1,737.80 | $3,311.31 | $5,754.40 |