- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $91.20 / $269.15
| Professional | | $67.61 | $91.20 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $77.62 / $151.36
| Professional | | $58.88 | $77.62 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $147.91 / $302.00
| Professional | | $57.54 | $147.91 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,548.13 / $7,244.36
| Facility | | $1,659.59 | $3,548.13 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $114.82 / $154.88
| Professional | | $81.28 | $114.82 | $154.88 |