- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $2,630.27 / $8,317.64
| Facility | | $245.47 | $2,630.27 | $8,317.64 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $1,230.27 / $3,162.28
| Professional | | $181.97 | $1,230.27 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $2,630.27
| Professional | | $1,548.82 | $1,949.84 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $977.24 / $2,089.30
| Facility | | $234.42 | $977.24 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $309.03 / $8,709.64
| Facility | | $204.17 | $309.03 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,244.36 / $14,125.38
| Facility | | $3,801.89 | $7,244.36 | $14,125.38 |