- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $3,630.78 / $8,317.64
| Facility | | $354.81 | $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
- $263.03 / $323.59 / $812.83
| Professional | | $263.03 | $323.59 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $724.44
| Professional | | $562.34 | $707.95 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $467.74 / $724.44
| Facility | | $302.00 | $467.74 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $501.19 / $8,709.64
| Facility | | $295.12 | $501.19 | $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 |