- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $933.25 / $2,691.53
| Facility | | $416.87 | $933.25 | $2,691.53 |
- 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
- $1,995.26 / $2,290.87 / $3,715.35
| Facility | | $1,995.26 | $2,290.87 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $851.14 / $3,162.28
| Facility | | $416.87 | $851.14 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $912.01 / $7,244.36
| Facility | | $416.87 | $912.01 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,548.82 / $2,818.38
| Professional | | $870.96 | $1,548.82 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,548.13 / $5,248.07
| Facility | | $1,905.46 | $3,548.13 | $5,248.07 |
- 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 |