- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $426.58 / $1,905.46
| Facility | | $213.80 | $426.58 | $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
- $1,023.29 / $1,202.26 / $1,905.46
| Facility | | $1,023.29 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $398.11 / $2,398.83
| Facility | | $204.17 | $398.11 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $416.87 / $3,235.94
| Facility | | $208.93 | $416.87 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $660.69 / $1,412.54
| Professional | | $323.59 | $660.69 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,630.78 / $3,630.78
| Facility | | $2,454.71 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,630.78 / $6,456.54
| Facility | | $2,884.03 | $3,630.78 | $6,456.54 |