- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.58 / $670.76 / $1,338.17
| Facility | | $305.58 | $670.76 | $1,338.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.70 / $269.64 / $2,156.48
| Professional | | $224.70 | $269.64 | $2,156.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.13 / $877.77 / $1,390.52
| Facility | | $231.13 | $877.77 | $1,390.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.06 / $320.08 / $1,550.43
| Professional | | $220.06 | $320.08 | $1,550.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.18 / $588.60 / $981.00
| Facility | | $216.18 | $588.60 | $981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.71 / $251.92 / $361.84
| Professional | | $152.71 | $251.92 | $361.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.17 / $335.38 / $670.76
| Facility | | $247.17 | $335.38 | $670.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.86 / $192.17 / $1,676.90
| Professional | | $140.86 | $192.17 | $1,676.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.86 / $191.88 / $201.23
| Professional | | $140.86 | $191.88 | $201.23 |