- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $7,943.28 / $16,595.87
| Facility | | $446.68 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $645.65
| Facility | | $34.67 | $562.34 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $691.83
| Professional | | $575.44 | $575.44 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $812.83
| Facility | | $380.19 | $537.03 | $812.83 |
- 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 |