- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $5,495.41 / $8,511.38
| Facility | | $346.74 | $5,495.41 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,882.50 / $20,892.96
| Facility | | $9,120.11 | $12,882.50 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,912.51 / $14,125.38
| Facility | | $7,585.78 | $8,912.51 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,818.38 / $5,248.07
| Facility | | $398.11 | $2,818.38 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $7,943.28 / $15,135.61
| Facility | | $398.11 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $2,884.03 / $9,120.11
| Professional | | $575.44 | $2,884.03 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $16,218.10
| Facility | | $10,964.78 | $10,964.78 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,378.01
| Facility | | $8,912.51 | $13,803.84 | $17,378.01 |