- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,096.48 / $6,456.54
| Facility | | $512.86 | $1,096.48 | $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
- $1,412.54 / $1,621.81 / $2,754.23
| Facility | | $1,412.54 | $1,621.81 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,096.48 / $5,495.41
| Facility | | $524.81 | $1,096.48 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,096.48 / $11,220.18
| Facility | | $524.81 | $1,096.48 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,202.26 / $1,819.70
| Professional | | $794.33 | $1,202.26 | $1,819.70 |
- 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 |