- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $5,248.07 / $7,079.46
| Facility | | $457.09 | $5,248.07 | $7,079.46 |
- 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
- $1,202.26 / $1,412.54 / $2,398.83
| Facility | | $1,202.26 | $1,412.54 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $954.99 / $8,317.64
| Facility | | $467.74 | $954.99 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,071.52 / $11,220.18
| Facility | | $467.74 | $1,071.52 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,047.13 / $1,584.89
| Professional | | $691.83 | $1,047.13 | $1,584.89 |
- 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 |