- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,905.46 / $10,232.93
| Facility | | $213.80 | $1,905.46 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $933.25
| Facility | | $501.19 | $588.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $269.15 / $3,162.28
| Facility | | $190.55 | $269.15 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $281.84 / $5,248.07
| Facility | | $190.55 | $281.84 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $407.38 / $645.65
| Professional | | $229.09 | $407.38 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $7,943.28
| Facility | | $5,370.32 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |