- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,951.21 / $7,244.36
| Facility | | $338.84 | $2,951.21 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,511.89 / $3,090.30
| Facility | | $489.78 | $2,511.89 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $912.01 / $1,548.82
| Professional | | $724.44 | $912.01 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,778.28 / $1,778.28
| Professional | | $1,071.52 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $630.96 / $1,230.27
| Facility | | $204.17 | $630.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $263.03 / $1,096.48
| Facility | | $199.53 | $263.03 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $6,025.60 / $13,803.84
| Facility | | $1,071.52 | $6,025.60 | $13,803.84 |