- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $831.76 / $3,090.30
| Facility | | $446.68 | $831.76 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,737.80 / $2,754.23
| Facility | | $1,479.11 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,071.52 / $3,715.35
| Facility | | $446.68 | $1,071.52 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,071.52 / $8,128.31
| Facility | | $446.68 | $1,071.52 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,202.26 / $1,862.09
| Professional | | $707.95 | $1,202.26 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,943.28 / $7,943.28
| Facility | | $5,370.32 | $7,943.28 | $7,943.28 |
- 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 |