- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,047.13 / $6,456.54
| Facility | | $204.17 | $1,047.13 | $6,456.54 |
- 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
- $2,691.53 / $3,090.30 / $5,011.87
| Facility | | $2,691.53 | $3,090.30 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,905.46 / $3,801.89
| Facility | | $234.42 | $1,905.46 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $4,265.80 / $11,481.54
| Facility | | $234.42 | $4,265.80 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,047.13 / $3,235.94
| Professional | | $346.74 | $1,047.13 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $9,332.54
| Facility | | $6,309.57 | $6,309.57 | $9,332.54 |
- 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 |