- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,370.32 / $9,772.37
| Facility | | $812.83 | $5,370.32 | $9,772.37 |
- 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
- $524.81 / $616.60 / $794.33
| Professional | | $524.81 | $616.60 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $831.76 / $870.96
| Professional | | $741.31 | $831.76 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,174.90
| Facility | | $549.54 | $758.58 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $8,709.64
| Facility | | $501.19 | $794.33 | $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 |