- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $134.90 / $1,905.46
| Facility | | $79.43 | $134.90 | $1,905.46 |
- 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
- $251.19 / $288.40 / $467.74
| Facility | | $251.19 | $288.40 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $1,698.24 / $3,801.89
| Facility | | $79.43 | $1,698.24 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $1,584.89 / $4,168.69
| Facility | | $79.43 | $1,584.89 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $199.53 / $346.74
| Professional | | $112.20 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,584.89
| Facility | | $1,047.13 | $1,047.13 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,818.38 / $4,677.35
| Facility | | $2,187.76 | $2,818.38 | $4,677.35 |