- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.73 / $1,161.66 / $7,984.75
| Facility | | $120.73 | $1,161.66 | $7,984.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.26 / $135.12 / $151.04
| Professional | | $100.26 | $135.12 | $151.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.58 / $157.68 / $199.32
| Professional | | $102.58 | $157.68 | $199.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,094.76 / $1,125.58 / $4,440.66
| Facility | | $1,094.76 | $1,125.58 | $4,440.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.52 / $163.47 / $391.31
| Professional | | $122.52 | $163.47 | $391.31 |