- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $3,162.28 / $4,570.88
| Facility | | $263.03 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $239.88 / $478.63
| Professional | | $109.65 | $239.88 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $223.87 / $489.78
| Professional | | $97.72 | $223.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $602.56
| Professional | | $32.36 | $33.11 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $512.86 / $1,122.02
| Facility | | $436.52 | $512.86 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $251.19 / $537.03
| Professional | | $162.18 | $251.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $288.40 / $691.83
| Professional | | $131.83 | $288.40 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $208.93 / $512.86
| Professional | | $104.71 | $208.93 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $208.93 / $389.05
| Professional | | $102.33 | $208.93 | $389.05 |