- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $8,317.64 / $8,317.64
| Facility | | $190.55 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,982.44 / $29,512.09
| Facility | | $12,022.64 | $16,982.44 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $457.09 / $724.44
| Facility | | $389.05 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $7,244.36 / $13,489.63
| Facility | | $194.98 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $9,772.37 / $17,378.01
| Facility | | $177.83 | $9,772.37 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $645.65
| Professional | | $251.19 | $363.08 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $24,547.09 / $24,547.09
| Facility | | $16,982.44 | $24,547.09 | $24,547.09 |
- 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 |