- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $724.44 / $3,090.30
| Facility | | $346.74 | $724.44 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,584.89 / $2,630.27
| Facility | | $1,348.96 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $616.60 / $3,548.13
| Facility | | $363.08 | $616.60 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $691.83 / $7,762.47
| Facility | | $371.54 | $691.83 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,071.52 / $1,659.59
| Professional | | $630.96 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,025.60 / $8,912.51
| Facility | | $3,235.94 | $6,025.60 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |