- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,380.38 / $14,454.40
| Facility | | $645.65 | $1,380.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $15,135.61 / $26,302.68
| Facility | | $10,715.19 | $15,135.61 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,041.74 / $3,235.94
| Facility | | $1,737.80 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,318.26 / $6,456.54
| Facility | | $660.69 | $1,318.26 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,380.38 / $11,481.54
| Facility | | $676.08 | $1,380.38 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,513.56 / $2,290.87
| Professional | | $1,000.00 | $1,513.56 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $19,952.62 / $19,952.62
| Facility | | $13,489.63 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $14,454.40
| Facility | | $6,606.93 | $10,232.93 | $14,454.40 |