- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $3,630.78 / $7,943.28
| Facility | | $245.47 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $173.78 / $288.40
| Professional | | $102.33 | $173.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $213.80
| Professional | | $141.25 | $141.25 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $186.21 / $316.23
| Professional | | $109.65 | $186.21 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $208.93 / $1,096.48
| Facility | | $91.20 | $208.93 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $223.87 / $1,380.38
| Professional | | $177.83 | $223.87 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $416.87 / $1,778.28
| Facility | | $173.78 | $416.87 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $173.78 / $263.03
| Professional | | $109.65 | $173.78 | $263.03 |