- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $645.65 / $2,187.76
| Facility | | $165.96 | $645.65 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $302.00 / $389.05
| Professional | | $147.91 | $302.00 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $204.17 / $1,659.59
| Facility | | $141.25 | $204.17 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $501.19 / $1,949.84
| Professional | | $144.54 | $501.19 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $245.47 / $245.47
| Professional | | $208.93 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $363.08
| Professional | | $245.47 | $331.13 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $223.87 / $407.38
| Facility | | $147.91 | $223.87 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $104.71 / $371.54
| Professional | | $87.10 | $104.71 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $245.47 / $245.47
| Professional | | $109.65 | $245.47 | $245.47 |