- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $8,317.64 / $17,782.79
| Facility | | $891.25 | $8,317.64 | $17,782.79 |
- 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
- $1,584.89 / $1,819.70 / $3,090.30
| Facility | | $1,584.89 | $1,819.70 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,174.90 / $6,456.54
| Facility | | $588.84 | $1,174.90 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,230.27 / $8,317.64
| Facility | | $588.84 | $1,230.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,348.96 / $2,041.74
| Professional | | $891.25 | $1,348.96 | $2,041.74 |
- 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
- $5,128.61 / $7,413.10 / $9,120.11
| Facility | | $5,128.61 | $7,413.10 | $9,120.11 |