- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,162.28 / $9,332.54
| Facility | | $549.54 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $660.69
| Professional | | $245.47 | $302.00 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $489.78 / $4,466.84
| Facility | | $275.42 | $489.78 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $323.59 / $602.56
| Professional | | $223.87 | $323.59 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $549.54 / $2,137.96
| Facility | | $194.98 | $549.54 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $354.81 / $812.83
| Professional | | $239.88 | $354.81 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,122.02 / $3,548.13
| Facility | | $288.40 | $1,122.02 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $288.40 / $549.54
| Professional | | $208.93 | $288.40 | $549.54 |