- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $3,235.94 / $8,317.64
| Facility | | $165.96 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $177.83 / $223.87
| Professional | | $151.36 | $177.83 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $177.83 / $281.84
| Facility | | $131.83 | $177.83 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $194.98 / $1,288.25
| Facility | | $144.54 | $194.98 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,202.26 / $2,454.71
| Facility | | $218.78 | $1,202.26 | $2,454.71 |