- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,096.48 / $14,454.40
| Facility | | $575.44 | $1,096.48 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,317.64 / $13,489.63
| Facility | | $5,011.87 | $8,317.64 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,621.81 / $2,570.40
| Facility | | $1,380.38 | $1,621.81 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,454.71 / $4,786.30
| Facility | | $588.84 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $7,079.46 / $12,302.69
| Facility | | $588.84 | $7,079.46 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,230.27 / $1,698.24
| Professional | | $630.96 | $1,230.27 | $1,698.24 |
- 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 |