- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $2,754.23 / $4,073.80
| Facility | | $151.36 | $2,754.23 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $162.18 / $346.74
| Professional | | $107.15 | $162.18 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $338.84 / $2,454.71
| Professional | | $131.83 | $338.84 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $186.21 / $398.11
| Professional | | $114.82 | $186.21 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $204.17 / $416.87
| Professional | | $194.98 | $204.17 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,737.80 / $5,128.61
| Facility | | $741.31 | $1,737.80 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $177.83 / $354.81
| Professional | | $114.82 | $177.83 | $354.81 |