- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $524.81 / $14,454.40
| Facility | | $213.80 | $524.81 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,090.30 / $5,754.40
| Facility | | $2,290.87 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $758.58 / $1,230.27
| Facility | | $660.69 | $758.58 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $776.25 / $4,265.80
| Facility | | $234.42 | $776.25 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $831.76 / $11,481.54
| Facility | | $257.04 | $831.76 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $575.44 / $851.14
| Professional | | $398.11 | $575.44 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $1,659.59
| Facility | | $660.69 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,232.93 / $12,589.25
| Facility | | $4,466.84 | $10,232.93 | $12,589.25 |