- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,071.52 / $3,981.07
| Facility | | $245.47 | $1,071.52 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $190.55 / $295.12
| Professional | | $91.20 | $190.55 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,148.15
| Facility | | $831.76 | $831.76 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $138.04 / $295.12
| Professional | | $104.71 | $138.04 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $512.86 / $562.34
| Facility | | $131.83 | $512.86 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $204.17 / $354.81
| Professional | | $100.00 | $204.17 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,230.27 / $2,570.40
| Facility | | $562.34 | $1,230.27 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $190.55 / $331.13
| Professional | | $95.50 | $190.55 | $331.13 |