- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $1,258.93 / $3,715.35
| Facility | | $194.98 | $1,258.93 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $147.91 / $245.47
| Professional | | $91.20 | $147.91 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $138.04 / $169.82
| Professional | | $102.33 | $138.04 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $512.86 / $776.25
| Facility | | $269.15 | $512.86 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $162.18 / $234.42
| Professional | | $120.23 | $162.18 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $165.96 / $234.42
| Professional | | $104.71 | $165.96 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $501.19 / $1,202.26
| Facility | | $213.80 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $151.36 / $245.47
| Professional | | $100.00 | $151.36 | $245.47 |