- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $870.96 / $6,456.54
| Facility | | $407.38 | $870.96 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $13,182.57
| Facility | | $5,011.87 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $3,019.95
| Facility | | $1,548.82 | $1,819.70 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $676.08 / $4,677.35
| Facility | | $389.05 | $676.08 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $794.33 / $7,762.47
| Facility | | $389.05 | $794.33 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,288.25 / $1,949.84
| Professional | | $758.58 | $1,288.25 | $1,949.84 |
- 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
- $5,128.61 / $7,413.10 / $9,120.11
| Facility | | $5,128.61 | $7,413.10 | $9,120.11 |