- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $537.03 / $1,288.25
| Facility | | $199.53 | $537.03 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $245.47 / $954.99
| Professional | | $223.87 | $245.47 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $309.03 / $524.81
| Professional | | $245.47 | $309.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $263.03 / $977.24
| Facility | | $138.04 | $263.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $323.59 / $3,467.37
| Professional | | $165.96 | $323.59 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $4,168.69 / $6,760.83
| Facility | | $104.71 | $4,168.69 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $204.17 / $512.86
| Professional | | $158.49 | $204.17 | $512.86 |