- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,630.78 / $8,317.64
| Facility | | $912.01 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,302.69 / $17,782.79
| Facility | | $9,772.37 | $12,302.69 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $851.14 / $2,137.96
| Professional | | $691.83 | $851.14 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $954.99 / $1,862.09
| Professional | | $758.58 | $954.99 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,047.13 / $1,659.59
| Facility | | $794.33 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $8,709.64
| Facility | | $707.95 | $1,071.52 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,413.10 / $14,125.38
| Facility | | $3,890.45 | $7,413.10 | $14,125.38 |