- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $851.14 / $3,090.30
| Facility | | $229.09 | $851.14 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,288.25 / $2,041.74
| Facility | | $1,096.48 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $741.31 / $3,715.35
| Facility | | $251.19 | $741.31 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $724.44 / $1,737.80
| Facility | | $269.15 | $724.44 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $1,479.11
| Professional | | $524.81 | $891.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,995.26 / $1,995.26
| Facility | | $1,258.93 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,137.96
| Facility | | $1,023.29 | $1,584.89 | $2,137.96 |