- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $1,288.25 / $3,890.45
| Facility | | $147.91 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $109.65 / $177.83
| Professional | | $56.23 | $109.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Professional | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,754.23 / $6,025.60
| Facility | | $371.54 | $2,754.23 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $104.71 / $162.18
| Professional | | $60.26 | $104.71 | $162.18 |
- 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
- $60.26 / $112.20 / $204.17
| Professional | | $60.26 | $112.20 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,467.37 / $8,511.38
| Facility | | $891.25 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $109.65 / $194.98
| Professional | | $56.23 | $109.65 | $194.98 |