- 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
- $43.43 / $101.34 / $221.34
| Professional | | $43.43 | $101.34 | $221.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.57 / $83.78 / $181.15
| Professional | | $45.57 | $83.78 | $181.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.00 / $138.97 / $253.28
| Professional | | $64.00 | $138.97 | $253.28 |
- 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
- $71.20 / $131.22 / $257.13
| Professional | | $71.20 | $131.22 | $257.13 |