- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $218.78 / $1,905.46
| Facility | | $75.86 | $218.78 | $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
- $616.60 / $724.44 / $1,148.15
| Facility | | $616.60 | $724.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $239.88 / $3,162.28
| Facility | | $83.18 | $239.88 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $245.47 / $3,630.78
| Facility | | $89.13 | $245.47 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $380.19 / $870.96
| Professional | | $147.91 | $380.19 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $2,089.30
| Facility | | $758.58 | $1,445.44 | $2,089.30 |
- 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 |