- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.18 / $354.63 / $7,205.22
| Facility | | $103.18 | $354.63 | $7,205.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.68 / $132.37 / $152.51
| Professional | | $90.68 | $132.37 | $152.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.29 / $151.22 / $226.58
| Professional | | $110.29 | $151.22 | $226.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.24 / $1,159.24 / $1,420.08
| Facility | | $1,159.24 | $1,159.24 | $1,420.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.02 / $182.23 / $329.55
| Professional | | $143.02 | $182.23 | $329.55 |