- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $467.74 / $467.74
| Facility | | $208.93 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $676.08 / $1,096.48
| Facility | | $588.84 | $676.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $457.09 / $5,754.40
| Facility | | $223.87 | $457.09 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $467.74 / $5,623.41
| Facility | | $223.87 | $467.74 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $812.83
| Professional | | $354.81 | $549.54 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,513.56
| Facility | | $588.84 | $588.84 | $1,513.56 |
- 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 |