- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $5,888.44 / $15,135.61
| Facility | | $154.88 | $5,888.44 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,248.07 / $7,079.46
| Facility | | $3,467.37 | $5,248.07 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $131.83 / $162.18
| Professional | | $109.65 | $131.83 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $436.52 / $549.54
| Professional | | $295.12 | $436.52 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $269.15 / $524.81
| Facility | | $125.89 | $269.15 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $338.84 / $7,413.10
| Facility | | $134.90 | $338.84 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |