- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $8,317.64 / $19,498.45
| Facility | | $489.78 | $8,317.64 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,882.50 / $22,387.21
| Facility | | $9,120.11 | $12,882.50 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,412.54 / $2,238.72
| Facility | | $1,202.26 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $4,466.84 / $8,912.51
| Facility | | $457.09 | $4,466.84 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $8,709.64 / $16,595.87
| Facility | | $457.09 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,047.13 / $1,513.56
| Professional | | $537.03 | $1,047.13 | $1,513.56 |
- 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 |