- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,235.94 / $8,128.31
| Facility | | $407.38 | $3,235.94 | $8,128.31 |
- 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
- $489.78 / $524.81 / $616.60
| Facility | | $489.78 | $524.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,023.29 / $1,659.59
| Professional | | $812.83 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,187.76 / $2,187.76
| Professional | | $1,258.93 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $776.25 / $1,513.56
| Facility | | $204.17 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $269.15 / $1,071.52
| Facility | | $194.98 | $269.15 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,884.03 / $5,754.40
| Facility | | $512.86 | $2,884.03 | $5,754.40 |