- 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
- $34.90 / $74.00 / $140.22
| Professional | | $34.90 | $74.00 | $140.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.81 / $94.72 / $189.13
| Professional | | $56.81 | $94.72 | $189.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.52 / $112.33 / $244.21
| Professional | | $68.52 | $112.33 | $244.21 |
- 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
- $93.27 / $162.16 / $251.36
| Professional | | $93.27 | $162.16 | $251.36 |