- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,235.94 / $10,715.19
| Facility | | $741.31 | $3,235.94 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $13,182.57 / $15,488.17
| Facility | | $9,772.37 | $13,182.57 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $660.69 / $776.25
| Professional | | $524.81 | $660.69 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $707.95 / $1,380.38
| Professional | | $363.08 | $707.95 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $707.95 / $1,122.02
| Facility | | $416.87 | $707.95 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $724.44 / $7,413.10
| Facility | | $309.03 | $724.44 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |