- 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
- $54.52 / $87.59 / $238.37
| Professional | | $54.52 | $87.59 | $238.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.89 / $90.75 / $160.82
| Professional | | $57.89 | $90.75 | $160.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.90 / $128.27 / $247.84
| Professional | | $80.90 | $128.27 | $247.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.30 / $141.34 / $227.89
| Professional | | $79.30 | $141.34 | $227.89 |