- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $15,848.93 / $31,622.78
| Facility | | $660.69 | $15,848.93 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $407.38 / $616.60
| Facility | | $34.67 | $407.38 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $426.58
| Professional | | $363.08 | $363.08 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $524.81
| Facility | | $234.42 | $338.84 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $16,595.87 / $25,703.96
| Facility | | $1,698.24 | $16,595.87 | $25,703.96 |