- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $4,897.79 / $10,964.78
| Facility | | $416.87 | $4,897.79 | $10,964.78 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,288.25 / $1,412.54
| Facility | | $616.60 | $1,288.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $316.23 / $645.65
| Professional | | $263.03 | $316.23 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $467.74 / $660.69
| Professional | | $407.38 | $467.74 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $616.60
| Facility | | $295.12 | $407.38 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $380.19 / $1,445.44
| Facility | | $302.00 | $380.19 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $6,025.60 / $13,803.84
| Facility | | $1,071.52 | $6,025.60 | $13,803.84 |