- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $2,754.23 / $7,413.10
| Facility | | $204.17 | $2,754.23 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,288.25 / $2,089.30
| Facility | | $1,122.02 | $1,288.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $707.95 / $3,715.35
| Facility | | $245.47 | $707.95 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $691.83 / $7,762.47
| Facility | | $251.19 | $691.83 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $812.83 / $1,479.11
| Professional | | $467.74 | $812.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,760.83 / $6,760.83
| Facility | | $4,570.88 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |