- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,202.26 / $1,548.82
| Facility | | $218.78 | $1,202.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $309.03 / $398.11
| Professional | | $134.90 | $309.03 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $354.81 / $1,122.02
| Facility | | $346.74 | $354.81 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $741.31 / $1,174.90
| Facility | | $407.38 | $741.31 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $363.08
| Professional | | $251.19 | $346.74 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $1,174.90
| Professional | | $288.40 | $288.40 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $354.81 / $616.60
| Professional | | $323.59 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $245.47
| Professional | | $104.71 | $104.71 | $245.47 |