- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.42 / $236.04 / $1,435.12
| Facility | | $75.42 | $236.04 | $1,435.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.04 / $236.04 / $263.27
| Professional | | $236.04 | $236.04 | $263.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.03 / $241.62 / $396.33
| Facility | | $124.03 | $241.62 | $396.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.62 / $302.62 / $413.83
| Professional | | $302.62 | $302.62 | $413.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.60 / $613.70 / $1,725.45
| Facility | | $220.60 | $613.70 | $1,725.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.20 / $56.20 / $308.29
| Professional | | $26.20 | $56.20 | $308.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.33 / $76.00 / $393.41
| Facility | | $58.33 | $76.00 | $393.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.44 / $166.44 / $166.44
| Professional | | $166.44 | $166.44 | $166.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.62 / $302.62 / $302.62
| Facility | | $302.62 | $302.62 | $302.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $127.10 / $242.10
| Professional | | $29.38 | $127.10 | $242.10 |