- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $602.56
| Facility | | $309.03 | $309.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $10,964.78 / $14,125.38
| Facility | | $5,623.41 | $10,964.78 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $831.76
| Facility | | $416.87 | $562.34 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $229.09 / $537.03
| Facility | | $165.96 | $229.09 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $1,202.26 / $1,778.28
| Facility | | $177.83 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $489.78
| Professional | | $151.36 | $239.88 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,630.27 / $2,630.27
| Facility | | $371.54 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,137.96
| Facility | | $1,023.29 | $1,584.89 | $2,137.96 |