- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,318.26 / $14,454.40
| Facility | | $630.96 | $1,318.26 | $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
- $1,659.59 / $1,949.84 / $3,235.94
| Facility | | $1,659.59 | $1,949.84 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,258.93 / $6,456.54
| Facility | | $645.65 | $1,258.93 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,318.26 / $11,220.18
| Facility | | $645.65 | $1,318.26 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,445.44 / $2,187.76
| Professional | | $954.99 | $1,445.44 | $2,187.76 |
- 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 |