- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,090.30 / $3,090.30
| Facility | | $389.05 | $3,090.30 | $3,090.30 |
- 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
- $1,047.13 / $1,230.27 / $2,041.74
| Facility | | $1,047.13 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $707.95 / $3,981.07
| Facility | | $389.05 | $707.95 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $831.76 / $8,317.64
| Facility | | $389.05 | $831.76 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $1,380.38
| Professional | | $616.60 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,025.60 / $8,912.51
| Facility | | $3,235.94 | $6,025.60 | $8,912.51 |
- 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 |