- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $870.96 / $3,090.30
| Facility | | $407.38 | $870.96 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,762.47 / $12,589.25
| Facility | | $3,981.07 | $7,762.47 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,949.84 / $3,090.30
| Facility | | $1,659.59 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $741.31 / $3,548.13
| Facility | | $407.38 | $741.31 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $831.76 / $5,128.61
| Facility | | $407.38 | $831.76 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,380.38 / $2,290.87
| Professional | | $812.83 | $1,380.38 | $2,290.87 |
- 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 |