- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $2,630.27 / $8,317.64
| Facility | | $95.50 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $309.03 / $380.19
| Professional | | $257.04 | $309.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Professional | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $173.78 / $371.54
| Facility | | $81.28 | $173.78 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $112.20 / $2,691.53
| Facility | | $81.28 | $112.20 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,089.30 / $3,981.07
| Facility | | $1,071.52 | $2,089.30 | $3,981.07 |