- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $7,079.46 / $14,125.38
| Facility | | $177.83 | $7,079.46 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $114.82 / $281.84
| Professional | | $57.54 | $114.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $489.78
| Professional | | $147.91 | $234.42 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $316.23 / $741.31
| Facility | | $104.71 | $316.23 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $281.84 / $575.44
| Professional | | $120.23 | $281.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $616.60
| Professional | | $218.78 | $346.74 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $158.49 / $524.81
| Facility | | $58.88 | $158.49 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $112.20 / $275.42
| Professional | | $60.26 | $112.20 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $288.40 / $575.44
| Professional | | $104.71 | $288.40 | $575.44 |