- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,621.81 / $14,454.40
| Facility | | $851.14 | $1,621.81 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,964.78 / $18,197.01
| Facility | | $6,606.93 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $3,801.89
| Facility | | $2,041.74 | $2,398.83 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $6,760.83 / $13,489.63
| Facility | | $851.14 | $6,760.83 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $6,309.57 / $12,302.69
| Facility | | $851.14 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,862.09 / $2,570.40
| Professional | | $954.99 | $1,862.09 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,456.54 / $6,456.54
| Facility | | $2,041.74 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,232.93 / $12,589.25
| Facility | | $4,265.80 | $10,232.93 | $12,589.25 |