- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $436.52 / $1,905.46
| Facility | | $208.93 | $436.52 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $7,585.78
| Facility | | $3,311.31 | $4,897.79 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,122.02 / $1,862.09
| Facility | | $954.99 | $1,122.02 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $436.52 / $3,162.28
| Facility | | $213.80 | $436.52 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $436.52 / $7,244.36
| Facility | | $218.78 | $436.52 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $707.95 / $1,258.93
| Professional | | $398.11 | $707.95 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,570.88 / $6,760.83
| Facility | | $2,454.71 | $4,570.88 | $6,760.83 |
- 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 |