- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $1,380.38 / $6,760.83
| Facility | | $208.93 | $1,380.38 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $257.04 / $524.81
| Professional | | $114.82 | $257.04 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $2,511.89
| Facility | | $407.38 | $549.54 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $257.04 / $436.52
| Professional | | $128.82 | $257.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $257.04 / $489.78
| Professional | | $117.49 | $257.04 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $346.74 / $602.56
| Professional | | $125.89 | $346.74 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $331.13
| Professional | | $138.04 | $138.04 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $758.58 / $2,187.76
| Facility | | $154.88 | $758.58 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $234.42 / $436.52
| Professional | | $117.49 | $234.42 | $436.52 |