- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $6,165.95 / $14,454.40
| Facility | | $524.81 | $6,165.95 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,882.50 / $20,417.38
| Facility | | $9,120.11 | $12,882.50 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $15,135.61 / $24,547.09
| Facility | | $13,182.57 | $15,135.61 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $7,244.36 / $10,471.29
| Facility | | $524.81 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $8,709.64 / $16,595.87
| Facility | | $524.81 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $5,011.87 / $15,848.93
| Professional | | $741.31 | $5,011.87 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $39,810.72
| Facility | | $26,915.35 | $26,915.35 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |