- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,737.80 / $14,454.40
| Facility | | $933.25 | $1,737.80 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,128.31 / $13,803.84
| Facility | | $5,011.87 | $8,128.31 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,511.89 / $4,073.80
| Facility | | $2,187.76 | $2,511.89 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $8,128.31
| Facility | | $812.83 | $1,122.02 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $5,754.40
| Facility | | $851.14 | $1,148.15 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,949.84 / $3,019.95
| Professional | | $1,071.52 | $1,949.84 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,918.31 / $6,918.31
| Facility | | $2,187.76 | $6,918.31 | $6,918.31 |
- 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 |