- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $467.74 / $1,905.46
| Facility | | $186.21 | $467.74 | $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
- $1,122.02 / $1,318.26 / $2,089.30
| Facility | | $1,122.02 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $398.11 / $2,630.27
| Facility | | $169.82 | $398.11 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $426.58 / $3,630.78
| Facility | | $173.78 | $426.58 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $616.60 / $1,548.82
| Professional | | $275.42 | $616.60 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $3,630.78
| Facility | | $2,454.71 | $2,454.71 | $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 |