- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $288.40 / $575.44
| Facility | | $204.17 | $288.40 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $251.19
| Professional | | $104.71 | $144.54 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $2,137.96
| Facility | | $1,548.82 | $1,548.82 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $186.21 / $234.42
| Professional | | $162.18 | $186.21 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,344.23 / $5,495.41
| Facility | | $213.80 | $2,344.23 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $275.42 / $794.33
| Professional | | $138.04 | $275.42 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,011.87 / $9,332.54
| Facility | | $3,890.45 | $5,011.87 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $645.65
| Professional | | $147.91 | $234.42 | $645.65 |