- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,380.38 / $14,454.40
| Facility | | $851.14 | $1,380.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,128.31 / $14,125.38
| Facility | | $5,011.87 | $8,128.31 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,995.26 / $3,235.94
| Facility | | $1,737.80 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $7,244.36 / $13,489.63
| Facility | | $724.44 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,818.38 / $9,549.93
| Facility | | $724.44 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $2,884.03
| Professional | | $1,202.26 | $1,698.24 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $7,079.46 / $7,079.46
| Facility | | $1,698.24 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |