- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,862.09 / $5,011.87
| Facility | | $316.23 | $1,862.09 | $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
- $691.83 / $691.83 / $724.44
| Facility | | $691.83 | $691.83 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $295.12 / $588.84
| Professional | | $58.88 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,513.56 / $4,786.30
| Facility | | $407.38 | $1,513.56 | $4,786.30 |