- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $575.44 / $3,090.30
| Facility | | $245.47 | $575.44 | $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
- $1,380.38 / $1,621.81 / $2,570.40
| Facility | | $1,380.38 | $1,621.81 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $549.54 / $3,548.13
| Facility | | $245.47 | $549.54 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $575.44 / $7,762.47
| Facility | | $251.19 | $575.44 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $977.24 / $1,819.70
| Professional | | $549.54 | $977.24 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,912.51 / $8,912.51
| Facility | | $6,025.60 | $8,912.51 | $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 |