- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $4,168.69 / $10,964.78
| Facility | | $478.63 | $4,168.69 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $11,220.18 / $12,302.69
| Facility | | $9,772.37 | $11,220.18 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,884.03 / $3,801.89
| Facility | | $602.56 | $2,884.03 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $380.19 / $630.96
| Professional | | $316.23 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $489.78 / $691.83
| Professional | | $457.09 | $489.78 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $457.09 / $724.44
| Facility | | $338.84 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $426.58 / $1,659.59
| Facility | | $338.84 | $426.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $10,471.29 / $23,988.33
| Facility | | $2,137.96 | $10,471.29 | $23,988.33 |