- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,454.71 / $5,011.87
| Facility | | $426.58 | $2,454.71 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,467.37 / $4,466.84
| Facility | | $1,513.56 | $3,467.37 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $489.78 / $724.44
| Professional | | $269.15 | $489.78 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,584.89 / $4,786.30
| Facility | | $407.38 | $1,584.89 | $4,786.30 |