- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $1,949.84 / $6,025.60
| Facility | | $165.96 | $1,949.84 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,778.28 / $1,995.26
| Facility | | $1,513.56 | $1,778.28 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $616.60 / $1,023.29
| Facility | | $323.59 | $616.60 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Professional | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $204.17 / $338.84
| Facility | | $158.49 | $204.17 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,778.28 / $5,888.44
| Facility | | $398.11 | $1,778.28 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $19,498.45
| Facility | | $3,630.78 | $3,630.78 | $19,498.45 |