- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $4,073.80 / $7,762.47
| Facility | | $151.36 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $501.19
| Professional | | $120.23 | $151.36 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $1,202.26 / $2,454.71
| Professional | | $120.23 | $1,202.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $190.55 / $398.11
| Professional | | $144.54 | $190.55 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $302.00 / $338.84
| Professional | | $162.18 | $302.00 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $2,290.87
| Facility | | $213.80 | $549.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $177.83 / $331.13
| Professional | | $138.04 | $177.83 | $331.13 |