- 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
- $38.76 / $39.61 / $52.71
| Professional | | $38.76 | $39.61 | $52.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.75 / $45.59 / $76.33
| Professional | | $38.75 | $45.59 | $76.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.51 / $71.09 / $90.00
| Professional | | $33.51 | $71.09 | $90.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.06 / $53.01 / $72.01
| Professional | | $40.06 | $53.01 | $72.01 |