- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $295.12 / $1,905.46
| Facility | | $112.20 | $295.12 | $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
- $707.95 / $812.83 / $1,318.26
| Facility | | $707.95 | $812.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $257.04 / $2,238.72
| Facility | | $107.15 | $257.04 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $263.03 / $3,548.13
| Facility | | $109.65 | $263.03 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $363.08 / $912.01
| Professional | | $165.96 | $363.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $4,897.79
| Facility | | $3,311.31 | $4,897.79 | $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 |