- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $645.65 / $1,905.46
| Facility | | $72.44 | $645.65 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $1,621.81
| Facility | | $870.96 | $1,023.29 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $645.65 / $3,801.89
| Facility | | $74.13 | $645.65 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $1,949.84 / $4,168.69
| Facility | | $67.61 | $1,949.84 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $338.84 / $1,023.29
| Professional | | $117.49 | $338.84 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,548.13 / $3,548.13
| Facility | | $2,454.71 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,884.03 / $5,011.87
| Facility | | $2,344.23 | $2,884.03 | $5,011.87 |