- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $870.96 / $14,454.40
| Facility | | $389.05 | $870.96 | $14,454.40 |
- 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
- $1,122.02 / $1,288.25 / $2,089.30
| Facility | | $1,122.02 | $1,288.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $707.95 / $3,981.07
| Facility | | $389.05 | $707.95 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $851.14 / $8,128.31
| Facility | | $389.05 | $851.14 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $977.24 / $1,513.56
| Professional | | $645.65 | $977.24 | $1,513.56 |
- 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 |