- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $933.25 / $14,454.40
| Facility | | $436.52 | $933.25 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,412.54 / $2,238.72
| Facility | | $1,202.26 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $912.01 / $3,715.35
| Facility | | $436.52 | $912.01 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $933.25 / $5,623.41
| Facility | | $436.52 | $933.25 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $1,621.81
| Professional | | $707.95 | $1,071.52 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,235.94 / $4,786.30
| Facility | | $1,737.80 | $3,235.94 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,456.54
| Facility | | $2,884.03 | $3,801.89 | $6,456.54 |