- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,584.89 / $14,454.40
| Facility | | $776.25 | $1,584.89 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,317.64 / $13,182.57
| Facility | | $5,011.87 | $8,317.64 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,344.23 / $3,715.35
| Facility | | $1,995.26 | $2,344.23 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $5,128.61 / $9,549.93
| Facility | | $851.14 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $6,918.31 / $12,302.69
| Facility | | $851.14 | $6,918.31 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,778.28 / $3,019.95
| Professional | | $912.01 | $1,778.28 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,332.54 / $9,332.54
| Facility | | $6,309.57 | $9,332.54 | $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 |