- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $6,025.60 / $16,595.87
| Facility | | $281.84 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $5,128.61 / $10,232.93
| Facility | | $870.96 | $5,128.61 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $575.44 / $1,819.70
| Facility | | $234.42 | $575.44 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $338.84
| Professional | | $323.59 | $323.59 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $426.58
| Facility | | $147.91 | $251.19 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $10,232.93 / $16,982.44
| Facility | | $933.25 | $10,232.93 | $16,982.44 |