- 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
- $55.32 / $80.38 / $91.48
| Professional | | $55.32 | $80.38 | $91.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.54 / $97.86 / $136.54
| Professional | | $82.54 | $97.86 | $136.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.42 / $91.72 / $175.13
| Professional | | $57.42 | $91.72 | $175.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,052.00 / $5,510.00
| Facility | | $1,812.00 | $4,052.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.50 / $89.10 / $124.88
| Professional | | $62.50 | $89.10 | $124.88 |