- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,090.30 / $9,332.54
| Facility | | $616.60 | $3,090.30 | $9,332.54 |
- 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
- $1,698.24 / $1,995.26 / $3,162.28
| Facility | | $1,698.24 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,884.03 / $5,370.32
| Facility | | $660.69 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $9,549.93 / $16,595.87
| Facility | | $660.69 | $9,549.93 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,584.89 / $2,238.72
| Professional | | $812.83 | $1,584.89 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $16,218.10 / $16,218.10
| Facility | | $10,964.78 | $16,218.10 | $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 |