- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $1,122.02 / $3,388.44
| Facility | | $91.20 | $1,122.02 | $3,388.44 |
- 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
- $2,691.53 / $3,162.28 / $5,011.87
| Facility | | $2,691.53 | $3,162.28 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $912.01 / $2,630.27
| Facility | | $83.18 | $912.01 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $954.99 / $3,890.45
| Facility | | $85.11 | $954.99 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $1,148.15 / $3,548.13
| Professional | | $138.04 | $1,148.15 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $4,897.79
| Facility | | $3,311.31 | $3,311.31 | $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 |