- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,862.09 / $6,456.54
| Facility | | $489.78 | $1,862.09 | $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
- $1,318.26 / $1,548.82 / $2,454.71
| Facility | | $1,318.26 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,047.13 / $8,317.64
| Facility | | $501.19 | $1,047.13 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,096.48 / $11,220.18
| Facility | | $501.19 | $1,096.48 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,148.15 / $1,737.80
| Professional | | $758.58 | $1,148.15 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,912.51 / $8,912.51
| Facility | | $6,025.60 | $8,912.51 | $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 |