- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $144.54 / $144.54
| Facility | | $77.62 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,511.38 / $16,595.87
| Facility | | $6,456.54 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $138.04 / $1,778.28
| Facility | | $79.43 | $138.04 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $194.98 / $263.03
| Professional | | $181.97 | $194.98 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $4,570.88
| Facility | | $1,096.48 | $1,548.82 | $4,570.88 |