- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,148.15 / $14,454.40
| Facility | | $616.60 | $1,148.15 | $14,454.40 |
- 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
- $1,445.44 / $1,698.24 / $2,691.53
| Facility | | $1,445.44 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $707.95 / $8,128.31
| Facility | | $524.81 | $707.95 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $9,772.37
| Facility | | $524.81 | $758.58 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,288.25 / $1,995.26
| Professional | | $724.44 | $1,288.25 | $1,995.26 |
- 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
- $6,606.93 / $10,232.93 / $12,589.25
| Facility | | $6,606.93 | $10,232.93 | $12,589.25 |