- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $5,248.07 / $9,772.37
| Facility | | $371.54 | $5,248.07 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,128.61 / $9,120.11
| Facility | | $2,398.83 | $5,128.61 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Professional | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $549.54
| Facility | | $229.09 | $354.81 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $11,220.18 / $16,982.44
| Facility | | $2,754.23 | $11,220.18 | $16,982.44 |