- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $1,288.25 / $2,691.53
| Facility | | $194.98 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $194.98 / $331.13
| Professional | | $128.82 | $194.98 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $154.88 / $1,445.44
| Facility | | $154.88 | $154.88 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $234.42 / $436.52
| Professional | | $128.82 | $234.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $977.24 / $1,862.09
| Facility | | $489.78 | $977.24 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $346.74
| Professional | | $144.54 | $218.78 | $346.74 |