- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.40 / $190.46 / $9,801.56
| Facility | | $107.40 | $190.46 | $9,801.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $107.40 / $473.01
| Professional | | $106.33 | $107.40 | $473.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.04 / $209.41 / $252.57
| Professional | | $136.04 | $209.41 | $252.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.19 / $316.42 / $369.16
| Facility | | $124.19 | $316.42 | $369.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.19 / $124.19 / $126.67
| Professional | | $124.19 | $124.19 | $126.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.16 / $2,126.16 / $2,126.16
| Facility | | $2,126.16 | $2,126.16 | $2,126.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.32 / $100.32 / $106.33
| Facility | | $100.32 | $100.32 | $106.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $106.33
| Professional | | $106.33 | $106.33 | $106.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.70 / $106.33 / $132.69
| Professional | | $95.70 | $106.33 | $132.69 |