- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $6,918.31 / $15,848.93
| Facility | | $144.54 | $6,918.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $154.88 / $269.15
| Facility | | $87.10 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Professional | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $154.88 / $234.42
| Facility | | $102.33 | $154.88 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,230.27 / $3,548.13
| Facility | | $380.19 | $1,230.27 | $3,548.13 |