- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $9,332.54 / $15,848.93
| Facility | | $812.83 | $9,332.54 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $676.08 / $1,071.52
| Facility | | $575.44 | $676.08 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $323.59 / $4,365.16
| Facility | | $218.78 | $323.59 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $4,897.79
| Facility | | $218.78 | $363.08 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $467.74 / $724.44
| Professional | | $257.04 | $467.74 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $4,897.79
| Facility | | $3,311.31 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |