- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,698.24 / $14,454.40
| Facility | | $758.58 | $1,698.24 | $14,454.40 |
- 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
- $2,137.96 / $2,511.89 / $3,981.07
| Facility | | $2,137.96 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,348.96 / $5,495.41
| Facility | | $794.33 | $1,348.96 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,698.24 / $8,128.31
| Facility | | $812.83 | $1,698.24 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,905.46 / $2,951.21
| Professional | | $1,258.93 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,548.13 / $5,888.44
| Facility | | $1,905.46 | $3,548.13 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |