- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,137.96 / $3,981.07
| Facility | | $575.44 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $181.97 / $537.03
| Professional | | $52.48 | $181.97 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $275.42 / $489.78
| Professional | | $48.98 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $123.03 / $794.33
| Professional | | $44.67 | $123.03 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,454.71 / $6,025.60
| Facility | | $1,380.38 | $2,454.71 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $309.03 / $707.95
| Professional | | $60.26 | $309.03 | $707.95 |