- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,235.94 / $9,332.54
| Facility | | $549.54 | $3,235.94 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $131.83 / $257.04
| Professional | | $114.82 | $131.83 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $218.78 / $407.38
| Facility | | $34.67 | $218.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $169.82 / $309.03
| Professional | | $109.65 | $169.82 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $53.70 / $58.88
| Facility | | $51.29 | $53.70 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $93.33 / $169.82
| Professional | | $79.43 | $93.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $177.83
| Professional | | $32.36 | $33.11 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,548.82 / $3,890.45
| Facility | | $204.17 | $1,548.82 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $275.42
| Professional | | $109.65 | $151.36 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $112.20
| Professional | | $97.72 | $97.72 | $112.20 |