- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $331.13 / $4,677.35
| Facility | | $141.25 | $331.13 | $4,677.35 |
- 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
- $416.87 / $478.63 / $776.25
| Facility | | $416.87 | $478.63 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $316.23 / $3,715.35
| Facility | | $141.25 | $316.23 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $323.59 / $8,317.64
| Facility | | $141.25 | $323.59 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $389.05 / $575.44
| Professional | | $199.53 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,495.41 / $5,495.41
| Facility | | $3,715.35 | $5,495.41 | $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 |