- 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
- $169.82 / $204.17 / $363.08
| Professional | | $169.82 | $204.17 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,762.47 / $10,471.29
| Facility | | $6,456.54 | $7,762.47 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $263.03 / $323.59
| Professional | | $190.55 | $263.03 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $616.60
| Professional | | $165.96 | $251.19 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $549.54 / $1,348.96
| Facility | | $251.19 | $549.54 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $204.17 / $389.05
| Professional | | $151.36 | $204.17 | $389.05 |