- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,445.44 / $2,238.72
| Facility | | $870.96 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $169.82 / $257.04
| Professional | | $120.23 | $169.82 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,862.09 / $2,511.89
| Facility | | $1,584.89 | $1,862.09 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $186.21 / $234.42
| Professional | | $138.04 | $186.21 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $218.78 / $512.86
| Professional | | $131.83 | $218.78 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $1,548.82
| Facility | | $251.19 | $588.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $151.36 / $204.17
| Professional | | $112.20 | $151.36 | $204.17 |