- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.75 / $48,668.69 / $57,788.85
| Facility | | $201.75 | $48,668.69 | $57,788.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $183.48 / $203.84
| Professional | | $183.48 | $183.48 | $203.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.41 / $183.48 / $275.22
| Facility | | $183.41 | $183.48 | $275.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $237.14 / $425.41
| Professional | | $183.48 | $237.14 | $425.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.09 / $181.09 / $183.48
| Facility | | $173.09 | $181.09 | $183.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $183.48 / $190.40
| Professional | | $183.48 | $183.48 | $190.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.84 / $512.84 / $721.02
| Facility | | $512.84 | $512.84 | $721.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $203.66 / $217.31
| Professional | | $183.48 | $203.66 | $217.31 |