- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $239.88 / $14,454.40
| Facility | | $147.91 | $239.88 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,786.30 / $7,413.10
| Facility | | $3,162.28 | $4,786.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $346.74 / $562.34
| Facility | | $302.00 | $346.74 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $7,244.36 / $13,489.63
| Facility | | $138.04 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $2,818.38 / $9,549.93
| Facility | | $138.04 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $295.12 / $426.58
| Professional | | $190.55 | $295.12 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,288.25 / $1,288.25
| Facility | | $302.00 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |