- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,047.13 / $3,548.13
| Facility | | $213.80 | $1,047.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,162.28 / $5,128.61
| Facility | | $2,691.53 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $2,041.74 / $3,801.89
| Facility | | $245.47 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $4,073.80 / $8,317.64
| Facility | | $245.47 | $4,073.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,096.48 / $3,467.37
| Professional | | $371.54 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $5,495.41
| Facility | | $3,715.35 | $3,715.35 | $5,495.41 |
- 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 |