- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $4,897.79 / $16,595.87
| Facility | | $371.54 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,548.82 / $5,248.07
| Facility | | $588.84 | $1,548.82 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $426.58 / $1,318.26
| Facility | | $223.87 | $426.58 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $234.42
| Professional | | $208.93 | $208.93 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $263.03 / $691.83
| Facility | | $144.54 | $263.03 | $691.83 |
- 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 |