- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,454.71 / $5,011.87
| Facility | | $346.74 | $2,454.71 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,467.37 / $4,466.84
| Facility | | $1,513.56 | $3,467.37 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $181.97
| Facility | | $131.83 | $131.83 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $281.84 / $446.68
| Professional | | $123.03 | $281.84 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,047.13 / $1,995.26
| Facility | | $199.53 | $1,047.13 | $1,995.26 |