- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,235.94 / $7,943.28
| Facility | | $467.74 | $3,235.94 | $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
- $489.78 / $870.96 / $870.96
| Facility | | $489.78 | $870.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $275.42 / $549.54
| Professional | | $229.09 | $275.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $616.60 / $616.60
| Professional | | $416.87 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $346.74 / $549.54
| Facility | | $263.03 | $346.74 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $354.81 / $1,174.90
| Facility | | $269.15 | $354.81 | $1,174.90 |
- 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 |