- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $602.56 / $5,495.41
| Facility | | $371.54 | $602.56 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,230.27 / $1,380.38
| Facility | | $1,047.13 | $1,230.27 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $758.58 / $2,290.87
| Facility | | $338.84 | $758.58 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $398.11 / $660.69
| Facility | | $257.04 | $398.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,041.74 / $5,888.44
| Facility | | $398.11 | $2,041.74 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $19,498.45
| Facility | | $7,943.28 | $7,943.28 | $19,498.45 |