- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $309.03 / $1,905.46
| Facility | | $112.20 | $309.03 | $1,905.46 |
- 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
- $741.31 / $870.96 / $1,380.38
| Facility | | $741.31 | $870.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $263.03 / $2,238.72
| Facility | | $102.33 | $263.03 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $275.42 / $3,235.94
| Facility | | $104.71 | $275.42 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $407.38 / $1,023.29
| Professional | | $173.78 | $407.38 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,630.78 / $3,630.78
| Facility | | $2,454.71 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,630.78 / $6,456.54
| Facility | | $2,884.03 | $3,630.78 | $6,456.54 |