- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $3,715.35 / $10,964.78
| Facility | | $177.83 | $3,715.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $194.98 / $295.12
| Professional | | $91.20 | $194.98 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $114.82 / $7,762.47
| Facility | | $87.10 | $114.82 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $186.21 / $371.54
| Professional | | $93.33 | $186.21 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $501.19 / $1,737.80
| Facility | | $162.18 | $501.19 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $218.78 / $489.78
| Professional | | $104.71 | $218.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $87.10 / $204.17
| Facility | | $72.44 | $87.10 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $190.55 / $371.54
| Professional | | $95.50 | $190.55 | $371.54 |