- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $4,570.88
| Facility | | $281.84 | $426.58 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $102.33 / $380.19
| Professional | | $70.79 | $102.33 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $281.84
| Professional | | $234.42 | $234.42 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $426.58 / $4,570.88
| Facility | | $69.18 | $426.58 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $208.93 / $323.59
| Professional | | $114.82 | $208.93 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $426.58
| Professional | | $186.21 | $316.23 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $107.15 / $512.86
| Facility | | $67.61 | $107.15 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $131.83 / $275.42
| Professional | | $60.26 | $131.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $223.87 / $338.84
| Professional | | $100.00 | $223.87 | $338.84 |