- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.87 / $1,584.89 / $5,495.41
| Facility | | $0.87 | $1,584.89 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $7,585.78
| Facility | | $3,311.31 | $4,897.79 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $1,148.15
| Facility | | $616.60 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $302.00 / $5,248.07
| Facility | | $218.78 | $302.00 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $7,762.47
| Facility | | $218.78 | $316.23 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $501.19 / $776.25
| Professional | | $275.42 | $501.19 | $776.25 |
- 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 |