- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,235.94 / $6,456.54
| Facility | | $691.83 | $3,235.94 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,317.64 / $13,182.57
| Facility | | $5,011.87 | $8,317.64 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,137.96 / $3,388.44
| Facility | | $1,819.70 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,412.54 / $5,495.41
| Facility | | $707.95 | $1,412.54 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,445.44 / $11,220.18
| Facility | | $707.95 | $1,445.44 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,584.89 / $2,398.83
| Professional | | $1,047.13 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,025.60 / $8,912.51
| Facility | | $3,235.94 | $6,025.60 | $8,912.51 |
- 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 |