- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.36 / $72.47 / $171.43
| Professional | | $30.36 | $72.47 | $171.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.25 / $95.55 / $222.07
| Professional | | $60.25 | $95.55 | $222.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.18 / $90.11 / $272.57
| Professional | | $34.18 | $90.11 | $272.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.08 / $190.51 / $270.14
| Professional | | $140.08 | $190.51 | $270.14 |