- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $309.03 / $12,589.25
| Facility | | $72.44 | $309.03 | $12,589.25 |
- 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
- $147.91 / $169.82 / $275.42
| Facility | | $147.91 | $169.82 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $2,630.27 / $5,128.61
| Facility | | $67.61 | $2,630.27 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $1,202.26 / $1,778.28
| Facility | | $64.57 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $245.47
| Professional | | $104.71 | $147.91 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $1,288.25 / $1,288.25
| Facility | | $147.91 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $1,949.84
| Facility | | $1,023.29 | $1,584.89 | $1,949.84 |