- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $1,288.25 / $2,041.74
| Facility | | $144.54 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $117.49 / $165.96
| Professional | | $104.71 | $117.49 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $181.97 / $257.04
| Professional | | $120.23 | $181.97 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $346.74 / $851.14
| Facility | | $128.82 | $346.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $134.90 / $223.87
| Professional | | $107.15 | $134.90 | $223.87 |