- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $3,630.78 / $8,317.64
| Facility | | $295.12 | $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
- $229.09 / $288.40 / $724.44
| Professional | | $229.09 | $288.40 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $446.68 / $616.60
| Professional | | $363.08 | $446.68 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $380.19 / $575.44
| Facility | | $263.03 | $380.19 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $8,709.64
| Facility | | $251.19 | $354.81 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |