- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $263.03 / $467.74
| Professional | | $107.15 | $263.03 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,623.41 / $7,585.78
| Facility | | $4,677.35 | $5,623.41 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $190.55 / $338.84
| Professional | | $81.28 | $190.55 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $245.47 / $501.19
| Professional | | $107.15 | $245.47 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $524.81 / $1,348.96
| Facility | | $251.19 | $524.81 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $208.93 / $416.87
| Professional | | $87.10 | $208.93 | $416.87 |