- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $4,897.79 / $16,595.87
| Facility | | $125.89 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $660.69 / $2,754.23
| Facility | | $524.81 | $660.69 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $891.25
| Facility | | $186.21 | $186.21 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $257.04
| Professional | | $213.80 | $213.80 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $154.88 / $281.84
| Facility | | $107.15 | $154.88 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,202.26 / $3,548.13
| Facility | | $354.81 | $1,202.26 | $3,548.13 |