- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $3,090.30 / $6,025.60
| Facility | | $380.19 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,258.93 / $1,995.26
| Facility | | $1,071.52 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $794.33 / $3,981.07
| Facility | | $407.38 | $794.33 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $831.76 / $8,128.31
| Facility | | $407.38 | $831.76 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $933.25 / $1,412.54
| Professional | | $616.60 | $933.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,548.13 / $5,248.07
| Facility | | $1,905.46 | $3,548.13 | $5,248.07 |
- 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 |