- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $5,011.87 / $8,317.64
| Facility | | $457.09 | $5,011.87 | $8,317.64 |
- 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
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $478.63 / $575.44
| Professional | | $380.19 | $478.63 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $954.99
| Professional | | $524.81 | $645.65 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $512.86 / $812.83
| Facility | | $380.19 | $512.86 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $3,388.44
| Facility | | $363.08 | $512.86 | $3,388.44 |
- 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 |