- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $758.58 / $3,548.13
| Facility | | $120.23 | $758.58 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $380.19
| Professional | | $104.71 | $104.71 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $208.93 / $213.80
| Facility | | $158.49 | $208.93 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $107.15
| Professional | | $104.71 | $104.71 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $109.65 / $147.91
| Professional | | $72.44 | $109.65 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $245.47 / $467.74
| Facility | | $208.93 | $245.47 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $114.82 / $151.36
| Professional | | $104.71 | $114.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $74.13 / $371.54
| Professional | | $72.44 | $74.13 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $109.65 / $162.18
| Professional | | $97.72 | $109.65 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $109.65
| Professional | | $104.71 | $104.71 | $109.65 |