- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,089.30 / $6,606.93
| Facility | | $288.40 | $2,089.30 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $457.09
| Professional | | $151.36 | $257.04 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $275.42 / $416.87
| Professional | | $181.97 | $275.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $316.23 / $1,548.82
| Facility | | $154.88 | $316.23 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $302.00 / $2,187.76
| Professional | | $229.09 | $302.00 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $616.60 / $1,659.59
| Facility | | $138.04 | $616.60 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $218.78 / $331.13
| Professional | | $138.04 | $218.78 | $331.13 |