- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.07 / $1,654.16 / $9,491.90
| Facility | | $111.07 | $1,654.16 | $9,491.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.92 / $132.84 / $157.21
| Professional | | $93.92 | $132.84 | $157.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.89 / $163.72 / $198.57
| Professional | | $91.89 | $163.72 | $198.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.53 / $998.32 / $3,623.25
| Facility | | $977.53 | $998.32 | $3,623.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.70 / $155.32 / $226.09
| Professional | | $114.70 | $155.32 | $226.09 |