- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.23 / $685.15 / $1,328.37
| Professional | | $178.23 | $685.15 | $1,328.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,434.00 / $5,126.00 / $9,729.00
| Facility | | $3,434.00 | $5,126.00 | $9,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.94 / $276.38 / $462.72
| Professional | | $154.94 | $276.38 | $462.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.83 / $262.49 / $397.45
| Facility | | $145.83 | $262.49 | $397.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.44 / $263.80 / $474.84
| Professional | | $163.44 | $263.80 | $474.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.46 / $371.03 / $602.66
| Professional | | $210.46 | $371.03 | $602.66 |