- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $371.54 / $7,762.47
| Facility | | $151.36 | $371.54 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $186.21 / $323.59
| Professional | | $93.33 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $151.36 / $309.03
| Professional | | $93.33 | $151.36 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $1,659.59
| Facility | | $169.82 | $169.82 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $194.98 / $354.81
| Professional | | $112.20 | $194.98 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $295.12
| Professional | | $32.36 | $33.11 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $204.17 / $363.08
| Facility | | $95.50 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $223.87 / $380.19
| Professional | | $114.82 | $223.87 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $6,025.60 / $12,022.64
| Facility | | $645.65 | $6,025.60 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $204.17 / $354.81
| Professional | | $109.65 | $204.17 | $354.81 |