- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $7,943.28 / $16,595.87
| Facility | | $380.19 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $616.60
| Facility | | $34.67 | $562.34 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $588.84
| Professional | | $501.19 | $501.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $707.95
| Facility | | $323.59 | $457.09 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $6,165.95 / $8,912.51
| Facility | | $478.63 | $6,165.95 | $8,912.51 |