- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $3,162.28 / $7,762.47
| Facility | | $251.19 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $275.42 / $851.14
| Professional | | $245.47 | $275.42 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $457.09 / $2,454.71
| Professional | | $275.42 | $457.09 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $407.38 / $691.83
| Professional | | $269.15 | $407.38 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $512.86 / $758.58
| Professional | | $331.13 | $512.86 | $758.58 |
- 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
- $229.09 / $371.54 / $851.14
| Professional | | $229.09 | $371.54 | $851.14 |