- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,819.70 / $12,882.50
| Facility | | $457.09 | $1,819.70 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $17,378.01 / $28,840.32
| Facility | | $12,882.50 | $17,378.01 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $2,398.83
| Facility | | $1,288.25 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,981.07 / $7,413.10
| Facility | | $537.03 | $3,981.07 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $12,022.64 / $21,379.62
| Facility | | $537.03 | $12,022.64 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,096.48 / $2,137.96
| Professional | | $562.34 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,904.51 / $57,543.99 / $57,543.99
| Facility | | $38,904.51 | $57,543.99 | $57,543.99 |
- 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 |