- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.93 / $353.70 / $6,724.29
| Facility | | $128.93 | $353.70 | $6,724.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.34 / $116.77 / $140.07
| Professional | | $97.34 | $116.77 | $140.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.95 / $149.91 / $196.64
| Professional | | $101.95 | $149.91 | $196.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.67 / $883.54 / $5,130.85
| Facility | | $239.67 | $883.54 | $5,130.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.32 / $126.32 / $126.32
| Professional | | $126.32 | $126.32 | $126.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.24 / $138.78 / $292.39
| Professional | | $107.24 | $138.78 | $292.39 |