- 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
- $52.14 / $122.57 / $158.40
| Professional | | $52.14 | $122.57 | $158.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.57 / $100.21 / $223.78
| Professional | | $49.57 | $100.21 | $223.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.42 / $151.84 / $312.54
| Professional | | $59.42 | $151.84 | $312.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.54 / $188.01 / $283.31
| Professional | | $117.54 | $188.01 | $283.31 |