- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $478.63 / $2,454.71
| Facility | | $81.28 | $478.63 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $114.82 / $302.00
| Professional | | $72.44 | $114.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $1,202.26
| Professional | | $131.83 | $131.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $208.93 / $457.09
| Facility | | $85.11 | $208.93 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $251.19 / $446.68
| Professional | | $104.71 | $251.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $66,069.34 / $74,131.02
| Professional | | $54,954.09 | $66,069.34 | $74,131.02 |