- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $346.74 / $14,454.40
| Facility | | $173.78 | $346.74 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $501.19 / $812.83
| Facility | | $436.52 | $501.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $7,244.36 / $13,489.63
| Facility | | $173.78 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $2,818.38 / $9,549.93
| Facility | | $173.78 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $407.38 / $691.83
| Professional | | $213.80 | $407.38 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,096.48 / $1,096.48
| Facility | | $436.52 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |