- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,445.44 / $2,630.27
| Facility | | $245.47 | $1,445.44 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $128.82 / $245.47
| Professional | | $34.67 | $128.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,202.26 / $1,621.81
| Facility | | $1,000.00 | $1,202.26 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $107.15 / $165.96
| Professional | | $25.12 | $107.15 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $128.82 / $239.88
| Professional | | $35.48 | $128.82 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,148.15 / $2,511.89
| Facility | | $398.11 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $109.65 / $208.93
| Professional | | $28.84 | $109.65 | $208.93 |