- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $7,244.36 / $16,595.87
| Facility | | $478.63 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $870.96 / $933.25
| Facility | | $691.83 | $870.96 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $891.25
| Facility | | $302.00 | $501.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $407.38
| Professional | | $316.23 | $316.23 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $239.88 / $407.38
| Facility | | $169.82 | $239.88 | $407.38 |
- 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 |