- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,096.48 / $14,454.40
| Facility | | $501.19 | $1,096.48 | $14,454.40 |
- 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
- $1,380.38 / $1,584.89 / $2,570.40
| Facility | | $1,380.38 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $7,244.36 / $13,489.63
| Facility | | $575.44 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $12,022.64 / $21,379.62
| Facility | | $575.44 | $12,022.64 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,318.26 / $2,238.72
| Professional | | $676.08 | $1,318.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $34,673.69 / $34,673.69
| Facility | | $22,908.68 | $34,673.69 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $22,387.21
| Facility | | $8,709.64 | $16,982.44 | $22,387.21 |