- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $316.23 / $1,905.46
| Facility | | $141.25 | $316.23 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $812.83 / $1,318.26
| Facility | | $707.95 | $812.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $316.23 / $3,162.28
| Facility | | $151.36 | $316.23 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $346.74 / $3,630.78
| Facility | | $158.49 | $346.74 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $467.74 / $851.14
| Professional | | $263.03 | $467.74 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,445.44 / $2,137.96
| Facility | | $776.25 | $1,445.44 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $4,677.35
| Facility | | $2,238.72 | $2,818.38 | $4,677.35 |