- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $2,570.40 / $7,079.46
| Facility | | $416.87 | $2,570.40 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $489.78 / $1,230.27
| Professional | | $269.15 | $489.78 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $660.69 / $1,318.26
| Professional | | $537.03 | $660.69 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $501.19 / $794.33
| Facility | | $338.84 | $501.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $8,709.64
| Facility | | $295.12 | $426.58 | $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 |