- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.39 / $380.52 / $1,441.22
| Facility | | $140.39 | $380.52 | $1,441.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.33 / $565.69 / $1,012.28
| Professional | | $127.33 | $565.69 | $1,012.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.59 / $857.51 / $1,210.50
| Facility | | $353.59 | $857.51 | $1,210.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.54 / $575.66 / $1,481.75
| Professional | | $161.54 | $575.66 | $1,481.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.13 / $490.15 / $1,184.17
| Facility | | $216.13 | $490.15 | $1,184.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.30 / $445.48 / $1,499.31
| Professional | | $146.30 | $445.48 | $1,499.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.54 / $931.32 / $1,532.88
| Professional | | $546.54 | $931.32 | $1,532.88 |