- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $1,288.25 / $3,890.45
| Facility | | $190.55 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $165.96 / $316.23
| Professional | | $131.83 | $165.96 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $138.04 / $158.49
| Professional | | $120.23 | $138.04 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Facility | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $199.53 / $251.19
| Professional | | $162.18 | $199.53 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $158.49 / $158.49
| Facility | | $39.81 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $190.55 / $251.19
| Professional | | $131.83 | $190.55 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $512.86 / $1,258.93
| Facility | | $208.93 | $512.86 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $173.78 / $302.00
| Professional | | $128.82 | $173.78 | $302.00 |