- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $131.83 / $151.36
| Facility | | $114.82 | $131.83 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $83.18 / $2,344.23
| Professional | | $24.55 | $83.18 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $724.44 / $1,318.26
| Facility | | $275.42 | $724.44 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $309.03 / $489.78
| Professional | | $239.88 | $309.03 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,230.27 / $2,041.74
| Facility | | $316.23 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,071.52 / $1,412.54
| Professional | | $398.11 | $1,071.52 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,122.02 / $2,187.76
| Facility | | $316.23 | $1,122.02 | $2,187.76 |