- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $3,548.13 / $10,964.78
| Facility | | $288.40 | $3,548.13 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $8,511.38
| Facility | | $3,388.44 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $1,230.27
| Facility | | $426.58 | $741.31 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,096.48 / $1,445.44
| Professional | | $1,023.29 | $1,096.48 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,230.27 / $4,466.84
| Facility | | $309.03 | $1,230.27 | $4,466.84 |