- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $398.11 / $14,454.40
| Facility | | $234.42 | $398.11 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $933.25
| Facility | | $501.19 | $588.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $3,162.28 / $5,888.44
| Facility | | $229.09 | $3,162.28 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $7,244.36 / $12,302.69
| Facility | | $213.80 | $7,244.36 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $446.68 / $758.58
| Professional | | $229.09 | $446.68 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $9,120.11
| Facility | | $6,165.95 | $6,165.95 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $13,182.57
| Facility | | $6,606.93 | $10,232.93 | $13,182.57 |