- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $6,456.54 / $12,589.25
| Facility | | $407.38 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $17,782.79 / $29,512.09
| Facility | | $12,882.50 | $17,782.79 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $977.24 / $1,548.82
| Facility | | $831.76 | $977.24 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $7,413.10 / $14,454.40
| Facility | | $380.19 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $16,595.87 / $28,840.32
| Facility | | $363.08 | $16,595.87 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $1,380.38
| Professional | | $537.03 | $776.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $36,307.81
| Facility | | $24,547.09 | $24,547.09 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $20,417.38 / $33,113.11
| Facility | | $8,709.64 | $20,417.38 | $33,113.11 |