- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $1,230.27 / $9,332.54
| Facility | | $81.28 | $1,230.27 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $162.18 / $316.23
| Professional | | $75.86 | $162.18 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $251.19 / $380.19
| Professional | | $190.55 | $251.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $158.49 / $316.23
| Facility | | $102.33 | $158.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $245.47 / $954.99
| Professional | | $109.65 | $245.47 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $186.21 / $281.84
| Professional | | $165.96 | $186.21 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Professional | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $186.21 / $251.19
| Professional | | $128.82 | $186.21 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $177.83 / $309.03
| Professional | | $104.71 | $177.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $186.21 / $275.42
| Professional | | $151.36 | $186.21 | $275.42 |