- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $288.40 / $1,905.46
| Facility | | $114.82 | $288.40 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $6,165.95
| Facility | | $1,202.26 | $1,584.89 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $426.58 / $691.83
| Facility | | $371.54 | $426.58 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $302.00 / $3,981.07
| Facility | | $123.03 | $302.00 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $302.00 / $1,737.80
| Facility | | $131.83 | $302.00 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $363.08 / $512.86
| Professional | | $229.09 | $363.08 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $891.25
| Facility | | $354.81 | $354.81 | $891.25 |
- 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 |