- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,235.94 / $8,317.64
| Facility | | $295.12 | $3,235.94 | $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
- $524.81 / $870.96 / $977.24
| Facility | | $524.81 | $870.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,479.11 / $2,511.89
| Professional | | $1,174.90 | $1,479.11 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,090.30 / $3,090.30
| Professional | | $1,819.70 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,096.48 / $2,137.96
| Facility | | $269.15 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $346.74 / $1,412.54
| Facility | | $263.03 | $346.74 | $1,412.54 |
- 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 |