- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $3,388.44 / $6,025.60
| Facility | | $208.93 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $147.91 / $281.84
| Professional | | $125.89 | $147.91 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $190.55 / $213.80
| Professional | | $177.83 | $190.55 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $389.05
| Professional | | $32.36 | $33.11 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $302.00
| Professional | | $169.82 | $281.84 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $302.00 / $416.87
| Professional | | $117.49 | $302.00 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $208.93 / $245.47
| Professional | | $177.83 | $208.93 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $169.82 / $275.42
| Professional | | $131.83 | $169.82 | $275.42 |