- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $6,309.57
| Facility | | $1,445.44 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $48.98 / $147.91
| Professional | | $22.91 | $48.98 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $54.95
| Professional | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,348.96 / $1,995.26
| Facility | | $416.87 | $1,348.96 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $38.90 / $63.10
| Professional | | $21.88 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $46.77 / $81.28
| Professional | | $25.70 | $46.77 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.70 / $54.95 / $1,862.09
| Facility | | $25.70 | $54.95 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $60.26 / $446.68
| Professional | | $45.71 | $60.26 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,202.26 / $2,187.76
| Facility | | $524.81 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $43.65 / $64.57
| Professional | | $25.70 | $43.65 | $64.57 |