- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $5,248.07 / $9,772.37
| Facility | | $389.05 | $5,248.07 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,548.82 / $3,162.28
| Facility | | $812.83 | $1,548.82 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $354.81 / $588.84
| Facility | | $141.25 | $354.81 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $436.52
| Professional | | $416.87 | $416.87 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $616.60
| Facility | | $229.09 | $354.81 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,148.15 / $2,951.21
| Facility | | $199.53 | $1,148.15 | $2,951.21 |