- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,584.89 / $14,454.40
| Facility | | $724.44 | $1,584.89 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,882.50 / $22,387.21
| Facility | | $9,120.11 | $12,882.50 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,344.23 / $3,715.35
| Facility | | $1,995.26 | $2,344.23 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $6,918.31 / $13,489.63
| Facility | | $776.25 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,818.38 / $7,943.28
| Facility | | $776.25 | $2,818.38 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,905.46 / $3,311.31
| Professional | | $977.24 | $1,905.46 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $11,748.98 / $11,748.98
| Facility | | $1,995.26 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |