- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $398.11 / $14,454.40
| Facility | | $208.93 | $398.11 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $933.25
| Facility | | $501.19 | $588.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $245.47 / $2,818.38
| Facility | | $181.97 | $245.47 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $263.03 / $4,365.16
| Facility | | $181.97 | $263.03 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $446.68 / $691.83
| Professional | | $245.47 | $446.68 | $691.83 |
- 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 |