- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $4,897.79 / $8,317.64
| Facility | | $537.03 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $524.81 / $1,318.26
| Professional | | $426.58 | $524.81 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,096.48
| Professional | | $602.56 | $758.58 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $977.24
| Facility | | $478.63 | $676.08 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $8,709.64
| Facility | | $436.52 | $630.96 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |