- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,630.78 / $9,549.93
| Facility | | $741.31 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $616.60 / $758.58
| Professional | | $512.86 | $616.60 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,096.48 / $1,380.38
| Professional | | $851.14 | $1,096.48 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $891.25 / $1,348.96
| Facility | | $588.84 | $891.25 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $11,481.54
| Facility | | $549.54 | $812.83 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $12,882.50 / $29,512.09
| Facility | | $7,762.47 | $12,882.50 | $29,512.09 |