- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,047.13 / $6,456.54
| Facility | | $489.78 | $1,047.13 | $6,456.54 |
- 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
- $1,737.80 / $2,041.74 / $3,235.94
| Facility | | $1,737.80 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $812.83 / $4,677.35
| Facility | | $457.09 | $812.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $912.01 / $7,762.47
| Facility | | $457.09 | $912.01 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,513.56 / $2,187.76
| Professional | | $870.96 | $1,513.56 | $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
- $5,128.61 / $7,413.10 / $9,120.11
| Facility | | $5,128.61 | $7,413.10 | $9,120.11 |