- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.01 / $434.80 / $1,532.16
| Facility | | $283.01 | $434.80 | $1,532.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.68 / $159.36 / $163.19
| Professional | | $127.68 | $159.36 | $163.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.64 / $1,005.04 / $1,592.13
| Facility | | $264.64 | $1,005.04 | $1,592.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.96 / $366.49 / $1,775.18
| Professional | | $251.96 | $366.49 | $1,775.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.26 / $564.10 / $1,073.28
| Facility | | $128.26 | $564.10 | $1,073.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.27 / $384.00 / $668.16
| Facility | | $257.27 | $384.00 | $668.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.64 / $80.64 / $1,912.32
| Professional | | $80.64 | $80.64 | $1,912.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.64 / $80.64 / $161.28
| Professional | | $80.64 | $80.64 | $161.28 |