- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.37 / $2,482.69 / $9,388.75
| Facility | | $1,748.37 | $2,482.69 | $9,388.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $1,140.77 / $1,923.21
| Professional | | $17.05 | $1,140.77 | $1,923.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.26 / $52.87 / $66.09
| Professional | | $46.26 | $52.87 | $66.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.26 / $1,140.77 / $5,131.85
| Facility | | $31.26 | $1,140.77 | $5,131.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.36 / $37.79 / $5,749.92
| Professional | | $30.36 | $37.79 | $5,749.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.44 / $34.96 / $78.20
| Professional | | $29.44 | $34.96 | $78.20 |