- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.74 / $1,887.47 / $3,077.75
| Facility | | $45.74 | $1,887.47 | $3,077.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.46 / $1,023.66 / $1,377.62
| Professional | | $29.46 | $1,023.66 | $1,377.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.77 / $850.52 / $1,849.09
| Professional | | $33.77 | $850.52 | $1,849.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.57 / $1,077.57 / $1,077.57
| Professional | | $1,077.57 | $1,077.57 | $1,077.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,474.27 / $2,035.50 / $2,976.63
| Professional | | $1,474.27 | $2,035.50 | $2,976.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.66 / $1,699.56 / $2,353.61
| Professional | | $1,016.66 | $1,699.56 | $2,353.61 |