- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $3,630.78 / $8,317.64
| Facility | | $275.42 | $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
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $257.04 / $645.65
| Professional | | $208.93 | $257.04 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $426.58 / $562.34
| Professional | | $338.84 | $426.58 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $346.74 / $524.81
| Facility | | $239.88 | $346.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $331.13 / $8,709.64
| Facility | | $229.09 | $331.13 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,244.36 / $14,125.38
| Facility | | $3,801.89 | $7,244.36 | $14,125.38 |