- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $489.78 / $14,454.40
| Facility | | $218.78 | $489.78 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,786.30 / $7,413.10
| Facility | | $3,162.28 | $4,786.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $707.95 / $1,148.15
| Facility | | $616.60 | $707.95 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $478.63 / $10,000.00
| Facility | | $234.42 | $478.63 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $489.78 / $7,585.78
| Facility | | $234.42 | $489.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $812.83
| Professional | | $363.08 | $562.34 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,981.07 / $3,981.07
| Facility | | $616.60 | $3,981.07 | $3,981.07 |
- 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 |