- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $213.80 / $239.88
| Facility | | $97.72 | $213.80 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $112.20 / $177.83
| Professional | | $87.10 | $112.20 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,148.15 / $2,691.53
| Facility | | $467.74 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $190.55 / $331.13
| Professional | | $102.33 | $190.55 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $398.11 / $3,981.07
| Facility | | $61.66 | $398.11 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $165.96 / $288.40
| Professional | | $97.72 | $165.96 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Professional | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $309.03
| Facility | | $97.72 | $169.82 | $309.03 |
- 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
- $707.95 / $3,311.31 / $5,011.87
| Facility | | $707.95 | $3,311.31 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $263.03
| Professional | | $104.71 | $151.36 | $263.03 |