- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $5,011.87 / $13,803.84
| Facility | | $309.03 | $5,011.87 | $13,803.84 |
- 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
- $181.97 / $213.80 / $269.15
| Professional | | $181.97 | $213.80 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $489.78
| Professional | | $323.59 | $407.38 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $331.13 / $478.63
| Facility | | $213.80 | $331.13 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $302.00 / $11,481.54
| Facility | | $199.53 | $302.00 | $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 |