- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $691.83 / $1,905.46
| Facility | | $338.84 | $691.83 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $10,232.93 / $17,378.01
| Facility | | $3,162.28 | $10,232.93 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,258.93 / $1,995.26
| Facility | | $1,071.52 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $812.83 / $3,715.35
| Facility | | $338.84 | $812.83 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $831.76 / $6,165.95
| Facility | | $338.84 | $831.76 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $977.24 / $1,479.11
| Professional | | $489.78 | $977.24 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $26,915.35 / $26,915.35
| Facility | | $18,197.01 | $26,915.35 | $26,915.35 |
- 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 |