- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,630.78 / $8,317.64
| Facility | | $446.68 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $1,096.48
| Professional | | $354.81 | $436.52 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $588.84 / $912.01
| Professional | | $467.74 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $812.83
| Facility | | $389.05 | $549.54 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $524.81 / $8,709.64
| Facility | | $354.81 | $524.81 | $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 |