- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $4,073.80 / $8,317.64
| Facility | | $691.83 | $4,073.80 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,862.09 / $3,019.95
| Facility | | $1,621.81 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,981.07 / $8,912.51
| Facility | | $512.86 | $3,981.07 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $4,365.16 / $11,481.54
| Facility | | $512.86 | $4,365.16 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,479.11 / $2,290.87
| Professional | | $741.31 | $1,479.11 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $11,220.18
| Facility | | $7,585.78 | $7,585.78 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $12,589.25
| Facility | | $6,606.93 | $10,232.93 | $12,589.25 |