- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,318.26 / $4,168.69
| Facility | | $288.40 | $1,318.26 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,630.78 / $5,754.40
| Facility | | $3,090.30 | $3,630.78 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $1,122.02 / $2,754.23
| Facility | | $257.04 | $1,122.02 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,148.15 / $8,128.31
| Facility | | $263.03 | $1,148.15 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,230.27 / $3,630.78
| Professional | | $407.38 | $1,230.27 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $9,549.93
| Facility | | $6,456.54 | $6,456.54 | $9,549.93 |
- 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 |