- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.22 / $2,056.36 / $3,446.19
| Facility | | $204.22 | $2,056.36 | $3,446.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.71 / $327.45 / $1,172.65
| Professional | | $148.71 | $327.45 | $1,172.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.80 / $293.02 / $1,379.72
| Professional | | $184.80 | $293.02 | $1,379.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.49 / $327.62 / $1,595.42
| Professional | | $197.49 | $327.62 | $1,595.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.25 / $424.97 / $1,571.39
| Professional | | $184.25 | $424.97 | $1,571.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,149.72 / $2,758.22 / $5,383.54
| Facility | | $1,149.72 | $2,758.22 | $5,383.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.71 / $327.45 / $1,172.65
| Professional | | $148.71 | $327.45 | $1,172.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.98 / $1,452.38 / $1,720.09
| Professional | | $1,059.98 | $1,452.38 | $1,720.09 |