- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $9,772.37 / $12,302.69
| Facility | | $891.25 | $9,772.37 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,479.11 / $2,344.23
| Facility | | $1,258.93 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $5,248.07
| Facility | | $457.09 | $616.60 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $7,244.36
| Facility | | $457.09 | $645.65 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,122.02 / $1,778.28
| Professional | | $630.96 | $1,122.02 | $1,778.28 |
- 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
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |