- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $758.58 / $3,090.30
| Facility | | $407.38 | $758.58 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,232.93 / $18,197.01
| Facility | | $6,165.95 | $10,232.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,479.11 / $2,344.23
| Facility | | $1,258.93 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $2,884.03
| Facility | | $363.08 | $512.86 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $5,623.41
| Facility | | $371.54 | $524.81 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $977.24 / $1,584.89
| Professional | | $524.81 | $977.24 | $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 |