- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $5,248.07 / $7,585.78
| Facility | | $102.33 | $5,248.07 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $229.09
| Professional | | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $120.23 / $177.83
| Facility | | $102.33 | $120.23 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $758.58 / $1,949.84
| Facility | | $173.78 | $758.58 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $645.65 / $645.65
| Facility | | $56.23 | $645.65 | $645.65 |