- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,090.30 / $9,120.11
| Facility | | $602.56 | $3,090.30 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,232.93 / $17,378.01
| Facility | | $6,165.95 | $10,232.93 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,659.59 / $2,630.27
| Facility | | $1,412.54 | $1,659.59 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $707.95 / $3,162.28
| Facility | | $524.81 | $707.95 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $741.31 / $8,128.31
| Facility | | $524.81 | $741.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,122.02 / $1,737.80
| Professional | | $616.60 | $1,122.02 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $16,595.87
| Facility | | $11,220.18 | $11,220.18 | $16,595.87 |
- 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 |