- 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
- $147.91 / $181.97 / $407.38
| Professional | | $147.91 | $181.97 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,585.78 / $10,471.29
| Facility | | $6,165.95 | $7,585.78 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $173.78 / $263.03
| Professional | | $123.03 | $173.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $229.09 / $295.12
| Professional | | $162.18 | $229.09 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $1,548.82
| Facility | | $251.19 | $588.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $186.21 / $288.40
| Professional | | $131.83 | $186.21 | $288.40 |