- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $151.36 / $223.87
| Professional | | $112.20 | $151.36 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,071.52 / $1,445.44
| Facility | | $891.25 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $151.36 / $190.55
| Professional | | $93.33 | $151.36 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $169.82 / $288.40
| Professional | | $114.82 | $169.82 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,174.90 / $2,511.89
| Facility | | $407.38 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $223.87
| Professional | | $104.71 | $147.91 | $223.87 |