- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,348.96 / $14,454.40
| Facility | | $630.96 | $1,348.96 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $15,488.17 / $26,302.68
| Facility | | $11,481.54 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,995.26 / $3,162.28
| Facility | | $1,698.24 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,348.96 / $8,709.64
| Facility | | $645.65 | $1,348.96 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,412.54 / $15,135.61
| Facility | | $645.65 | $1,412.54 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,445.44 / $2,187.76
| Professional | | $933.25 | $1,445.44 | $2,187.76 |
- 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
- $7,585.78 / $12,302.69 / $16,595.87
| Facility | | $7,585.78 | $12,302.69 | $16,595.87 |