- 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
- $33.14 / $37.81 / $44.47
| Professional | | $33.14 | $37.81 | $44.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.56 / $45.42 / $61.19
| Professional | | $38.56 | $45.42 | $61.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.83 / $43.96 / $80.31
| Professional | | $26.83 | $43.96 | $80.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.94 / $44.65 / $61.18
| Professional | | $27.94 | $44.65 | $61.18 |