- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.81 / $1,190.70 / $7,792.26
| Facility | | $365.81 | $1,190.70 | $7,792.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.65 / $38.59 / $2,673.50
| Professional | | $34.65 | $38.59 | $2,673.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.47 / $327.16 / $809.07
| Facility | | $138.47 | $327.16 | $809.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.63 / $173.10 / $408.94
| Professional | | $140.63 | $173.10 | $408.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.40 / $125.40 / $125.40
| Professional | | $125.40 | $125.40 | $125.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.65 / $85.00 / $147.40
| Facility | | $34.65 | $85.00 | $147.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.40 / $147.40 / $147.40
| Professional | | $147.40 | $147.40 | $147.40 |