- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,047.13 / $2,570.40
| Facility | | $181.97 | $1,047.13 | $2,570.40 |
- 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
- $2,137.96 / $2,511.89 / $3,981.07
| Facility | | $2,137.96 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $776.25 / $3,090.30
| Facility | | $144.54 | $776.25 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $794.33 / $3,801.89
| Facility | | $147.91 | $794.33 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $831.76 / $2,511.89
| Professional | | $229.09 | $831.76 | $2,511.89 |
- 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 |