- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.10 / $143.34 / $777.57
| Facility | | $138.10 | $143.34 | $777.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.37 / $139.85 / $174.81
| Professional | | $122.37 | $139.85 | $174.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.73 / $157.33 / $183.73
| Facility | | $57.73 | $157.33 | $183.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.07 / $57.73 / $144.37
| Professional | | $49.07 | $57.73 | $144.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.77 / $2,294.38 / $5,514.85
| Facility | | $209.77 | $2,294.38 | $5,514.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.03 / $244.73 / $3,239.97
| Professional | | $201.03 | $244.73 | $3,239.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.63 / $136.02 / $230.67
| Facility | | $113.63 | $136.02 | $230.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.73 / $842.58 / $842.58
| Professional | | $202.73 | $842.58 | $842.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.81 / $174.81 / $209.77
| Facility | | $174.81 | $174.81 | $209.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.42 / $104.89 / $192.29
| Professional | | $73.42 | $104.89 | $192.29 |