- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,548.82 / $3,090.30
| Facility | | $295.12 | $1,548.82 | $3,090.30 |
- 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
- $630.96 / $724.44 / $1,174.90
| Facility | | $630.96 | $724.44 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,884.03 / $5,370.32
| Facility | | $295.12 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $6,918.31 / $12,302.69
| Facility | | $281.84 | $6,918.31 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $549.54 / $933.25
| Professional | | $281.84 | $549.54 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,120.11 / $9,120.11
| Facility | | $6,165.95 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $13,182.57
| Facility | | $6,606.93 | $10,232.93 | $13,182.57 |