- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $1,230.27 / $1,230.27
| Facility | | $165.96 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $128.82 / $177.83
| Professional | | $102.33 | $128.82 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $512.86 / $1,621.81
| Facility | | $426.58 | $512.86 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $199.53 / $263.03
| Professional | | $147.91 | $199.53 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $281.84
| Professional | | $32.36 | $60.26 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,230.27 / $1,698.24
| Facility | | $691.83 | $1,230.27 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $331.13 / $346.74
| Professional | | $186.21 | $331.13 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $190.55 / $302.00
| Professional | | $128.82 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $151.36 / $223.87
| Professional | | $34.67 | $151.36 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $147.91 / $218.78
| Professional | | $109.65 | $147.91 | $218.78 |