- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $912.01 / $2,818.38
| Facility | | $93.33 | $912.01 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,570.88 / $7,079.46
| Facility | | $2,344.23 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,570.40 / $4,073.80
| Facility | | $2,187.76 | $2,570.40 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $316.23 / $2,238.72
| Facility | | $85.11 | $316.23 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $323.59 / $3,548.13
| Facility | | $87.10 | $323.59 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $891.25 / $2,754.23
| Professional | | $138.04 | $891.25 | $2,754.23 |
- 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
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |