- 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
- $53.27 / $98.70 / $156.81
| Professional | | $53.27 | $98.70 | $156.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.42 / $119.78 / $209.64
| Professional | | $73.42 | $119.78 | $209.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.94 / $124.08 / $261.75
| Professional | | $78.94 | $124.08 | $261.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.16 / $140.38 / $265.76
| Professional | | $118.16 | $140.38 | $265.76 |