- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,258.93 / $14,454.40
| Facility | | $616.60 | $1,258.93 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,964.78 / $17,378.01
| Facility | | $6,606.93 | $10,964.78 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,819.70 / $2,951.21
| Facility | | $1,584.89 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,019.95 / $5,370.32
| Facility | | $660.69 | $3,019.95 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $6,918.31 / $12,882.50
| Facility | | $660.69 | $6,918.31 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,412.54 / $2,398.83
| Professional | | $724.44 | $1,412.54 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,454.40 / $14,454.40
| Facility | | $9,772.37 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $14,125.38
| Facility | | $6,606.93 | $10,232.93 | $14,125.38 |