- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,630.78 / $9,549.93
| Facility | | $954.99 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $19,054.61 / $26,302.68
| Facility | | $12,022.64 | $19,054.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $2,344.23
| Professional | | $741.31 | $933.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,659.59 / $1,862.09
| Professional | | $1,288.25 | $1,659.59 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $1,862.09
| Facility | | $851.14 | $1,230.27 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $5,248.07
| Facility | | $758.58 | $1,122.02 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |