- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $933.25 / $2,691.53
| Facility | | $104.71 | $933.25 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $239.88 / $724.44
| Professional | | $97.72 | $239.88 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $234.42 / $524.81
| Professional | | $104.71 | $234.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,819.70 / $3,548.13
| Facility | | $1,071.52 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $173.78
| Professional | | $107.15 | $107.15 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $416.87 / $1,318.26
| Facility | | $100.00 | $416.87 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $245.47 / $446.68
| Professional | | $100.00 | $245.47 | $446.68 |