- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $3,235.94 / $8,511.38
| Facility | | $239.88 | $3,235.94 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $194.98 / $234.42
| Professional | | $162.18 | $194.98 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $257.04 / $389.05
| Facility | | $186.21 | $257.04 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $281.84 / $1,288.25
| Facility | | $204.17 | $281.84 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,202.26 / $2,454.71
| Facility | | $218.78 | $1,202.26 | $2,454.71 |