- 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
- $64.53 / $103.72 / $303.31
| Professional | | $64.53 | $103.72 | $303.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.73 / $177.24 / $388.75
| Professional | | $73.73 | $177.24 | $388.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.47 / $207.05 / $580.69
| Professional | | $110.47 | $207.05 | $580.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.29 / $402.51 / $571.71
| Professional | | $274.29 | $402.51 | $571.71 |