- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.30 / $519.11 / $4,803.39
| Facility | | $136.30 | $519.11 | $4,803.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.34 / $152.75 / $201.99
| Professional | | $127.34 | $152.75 | $201.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.05 / $177.44 / $226.71
| Professional | | $123.05 | $177.44 | $226.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.61 / $1,546.38 / $2,537.12
| Facility | | $1,033.61 | $1,546.38 | $2,537.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.80 / $152.80 / $152.80
| Professional | | $152.80 | $152.80 | $152.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.47 / $201.21 / $423.95
| Professional | | $165.47 | $201.21 | $423.95 |