- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $457.09 / $1,905.46
| Facility | | $144.54 | $457.09 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,288.25 / $2,041.74
| Facility | | $1,096.48 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $371.54 / $2,454.71
| Facility | | $131.83 | $371.54 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $389.05 / $5,495.41
| Facility | | $138.04 | $389.05 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $562.34 / $1,513.56
| Professional | | $213.80 | $562.34 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $4,897.79
| Facility | | $3,311.31 | $4,897.79 | $4,897.79 |
- 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 |