- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $724.44 / $1,905.46
| Facility | | $389.05 | $724.44 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $10,232.93 / $17,378.01
| Facility | | $3,162.28 | $10,232.93 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,445.44 / $2,344.23
| Facility | | $1,258.93 | $1,445.44 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $2,238.72
| Facility | | $323.59 | $467.74 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $5,623.41
| Facility | | $323.59 | $478.63 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $933.25 / $1,584.89
| Professional | | $537.03 | $933.25 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,595.87 / $16,595.87
| Facility | | $11,220.18 | $16,595.87 | $16,595.87 |
- 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 |