- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $3,090.30 / $9,332.54
| Facility | | $288.40 | $3,090.30 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $13,182.57
| Facility | | $5,011.87 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,479.11 / $2,398.83
| Facility | | $1,288.25 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $933.25 / $4,265.80
| Facility | | $346.74 | $933.25 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $977.24 / $8,709.64
| Facility | | $346.74 | $977.24 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,148.15 / $1,778.28
| Professional | | $588.84 | $1,148.15 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $8,709.64 / $8,709.64
| Facility | | $5,888.44 | $8,709.64 | $8,709.64 |
- 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 |