- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $6,456.54 / $9,772.37
| Facility | | $812.83 | $6,456.54 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $15,135.61 / $26,302.68
| Facility | | $10,715.19 | $15,135.61 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,511.89 / $4,168.69
| Facility | | $2,137.96 | $2,511.89 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,698.24 / $5,495.41
| Facility | | $831.76 | $1,698.24 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,778.28 / $15,135.61
| Facility | | $831.76 | $1,778.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $2,754.23
| Professional | | $1,202.26 | $1,819.70 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,489.63 / $19,952.62
| Facility | | $7,244.36 | $13,489.63 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,302.69 / $16,595.87
| Facility | | $7,585.78 | $12,302.69 | $16,595.87 |