- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $812.83 / $3,090.30
| Facility | | $213.80 | $812.83 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,238.72 / $3,548.13
| Facility | | $1,905.46 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $676.08 / $3,162.28
| Facility | | $194.98 | $676.08 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $691.83 / $6,025.60
| Facility | | $199.53 | $691.83 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $891.25 / $2,570.40
| Professional | | $316.23 | $891.25 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $15,488.17
| Facility | | $10,715.19 | $10,715.19 | $15,488.17 |
- 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 |