- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $6,456.54 / $6,456.54
| Facility | | $602.56 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,862.09 / $2,951.21
| Facility | | $1,584.89 | $1,862.09 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,230.27 / $5,495.41
| Facility | | $602.56 | $1,230.27 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,258.93 / $5,754.40
| Facility | | $602.56 | $1,258.93 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $2,137.96
| Professional | | $933.25 | $1,412.54 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,570.88 / $6,760.83
| Facility | | $2,454.71 | $4,570.88 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |