- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,479.11 / $14,454.40
| Facility | | $707.95 | $1,479.11 | $14,454.40 |
- 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
- $1,862.09 / $2,187.76 / $3,467.37
| Facility | | $1,862.09 | $2,187.76 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,174.90 / $5,495.41
| Facility | | $707.95 | $1,174.90 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,479.11 / $11,220.18
| Facility | | $707.95 | $1,479.11 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,621.81 / $2,511.89
| Professional | | $1,071.52 | $1,621.81 | $2,511.89 |
- 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 |