- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,949.84 / $1,949.84
| Facility | | $186.21 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $131.83 / $190.55
| Professional | | $95.50 | $131.83 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $141.25 / $446.68
| Facility | | $114.82 | $141.25 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $190.55 / $234.42
| Professional | | $138.04 | $190.55 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $56.23 / $309.03
| Professional | | $42.66 | $56.23 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $407.38 / $562.34
| Facility | | $218.78 | $407.38 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $269.15
| Professional | | $186.21 | $218.78 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $81.28 / $302.00
| Professional | | $75.86 | $81.28 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $190.55 / $234.42
| Professional | | $114.82 | $190.55 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $288.40
| Professional | | $144.54 | $218.78 | $288.40 |