- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $389.05 / $3,235.94
| Facility | | $208.93 | $389.05 | $3,235.94 |
- 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
- $478.63 / $562.34 / $891.25
| Facility | | $478.63 | $562.34 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $245.47 / $3,162.28
| Facility | | $177.83 | $245.47 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $257.04 / $4,897.79
| Facility | | $177.83 | $257.04 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $380.19 / $588.84
| Professional | | $208.93 | $380.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $4,897.79
| Facility | | $3,311.31 | $3,311.31 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |