- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $4,168.69 / $8,912.51
| Facility | | $512.86 | $4,168.69 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $263.03 / $616.60
| Professional | | $120.23 | $263.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $158.49
| Facility | | $131.83 | $131.83 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Professional | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $1,318.26
| Facility | | $213.80 | $213.80 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $478.63 / $2,290.87
| Professional | | $123.03 | $478.63 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $8,912.51
| Facility | | $3,162.28 | $3,801.89 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $169.82
| Professional | | $162.18 | $162.18 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $4,570.88
| Facility | | $1,230.27 | $1,230.27 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $204.17 / $616.60
| Professional | | $109.65 | $204.17 | $616.60 |