- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $6,456.54 / $9,332.54
| Facility | | $316.23 | $6,456.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $7,585.78
| Facility | | $3,311.31 | $4,897.79 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $891.25 / $1,412.54
| Facility | | $758.58 | $891.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $275.42 / $3,630.78
| Facility | | $154.88 | $275.42 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $288.40 / $3,548.13
| Facility | | $158.49 | $288.40 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $512.86 / $1,047.13
| Professional | | $269.15 | $512.86 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,943.28 / $7,943.28
| Facility | | $5,370.32 | $7,943.28 | $7,943.28 |
- 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 |