- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $2,570.40 / $7,943.28
| Facility | | $177.83 | $2,570.40 | $7,943.28 |
- 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
- $338.84 / $870.96 / $977.24
| Facility | | $338.84 | $870.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $338.84 / $549.54
| Professional | | $275.42 | $338.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $389.05 / $524.81
| Professional | | $323.59 | $389.05 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $257.04 / $489.78
| Facility | | $117.49 | $257.04 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $794.33
| Facility | | $104.71 | $147.91 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,884.03 / $5,754.40
| Facility | | $512.86 | $2,884.03 | $5,754.40 |