- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $5,011.87 / $7,079.46
| Facility | | $630.96 | $5,011.87 | $7,079.46 |
- 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
- $1,698.24 / $1,949.84 / $3,162.28
| Facility | | $1,698.24 | $1,949.84 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $5,011.87 / $9,332.54
| Facility | | $660.69 | $5,011.87 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $5,623.41 / $8,317.64
| Facility | | $660.69 | $5,623.41 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,621.81 / $2,754.23
| Professional | | $831.76 | $1,621.81 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $6,760.83
| Facility | | $4,570.88 | $4,570.88 | $6,760.83 |
- 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 |