- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $5,888.44 / $6,456.54
| Facility | | $295.12 | $5,888.44 | $6,456.54 |
- 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
- $691.83 / $794.33 / $1,288.25
| Facility | | $691.83 | $794.33 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | 22 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $3,548.13
| Facility | | $251.19 | $346.74 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $363.08 / $4,897.79
| Facility | | $257.04 | $363.08 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $562.34 / $870.96
| Professional | | $309.03 | $562.34 | $870.96 |
- 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 |