- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $478.63 / $14,454.40
| Facility | | $257.04 | $478.63 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,570.88 / $7,079.46
| Facility | | $2,344.23 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $691.83 / $1,122.02
| Facility | | $602.56 | $691.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $302.00 / $3,162.28
| Facility | | $218.78 | $302.00 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $4,897.79
| Facility | | $223.87 | $316.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $489.78 / $758.58
| Professional | | $269.15 | $489.78 | $758.58 |
- 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 |