- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $3,630.78 / $8,317.64
| Facility | | $218.78 | $3,630.78 | $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
- $457.09 / $870.96 / $977.24
| Facility | | $457.09 | $870.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $199.53 / $398.11
| Professional | | $165.96 | $199.53 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $288.40 / $436.52
| Professional | | $263.03 | $288.40 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $263.03 / $426.58
| Facility | | $190.55 | $263.03 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $251.19 / $870.96
| Facility | | $190.55 | $251.19 | $870.96 |
- 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 |