- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.10 / $5,000.27 / $7,838.38
| Facility | | $138.10 | $5,000.27 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.03 / $131.03 / $138.10
| Professional | | $131.03 | $131.03 | $138.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $224.66
| Professional | | $60.00 | $85.00 | $224.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,401.00
| Facility | | $230.00 | $1,158.00 | $1,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.08 / $154.10 / $300.50
| Professional | | $145.08 | $154.10 | $300.50 |