- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $12,302.69 / $15,848.93
| Facility | | $691.83 | $12,302.69 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $17,378.01 / $29,512.09
| Facility | | $12,882.50 | $17,378.01 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $1,621.81
| Facility | | $870.96 | $1,023.29 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $7,413.10 / $14,454.40
| Facility | | $398.11 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $16,595.87 / $27,542.29
| Facility | | $398.11 | $16,595.87 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $1,445.44
| Professional | | $562.34 | $812.83 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $28,840.32 / $42,657.95
| Facility | | $28,840.32 | $28,840.32 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $20,417.38 / $33,884.42
| Facility | | $8,709.64 | $20,417.38 | $33,884.42 |