- 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
- $47.05 / $49.17 / $67.58
| Professional | | $47.05 | $49.17 | $67.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.60 / $59.53 / $96.14
| Professional | | $50.60 | $59.53 | $96.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.90 / $81.75 / $111.80
| Professional | | $47.90 | $81.75 | $111.80 |
- 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
- $47.47 / $67.54 / $97.60
| Professional | | $47.47 | $67.54 | $97.60 |