- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.49 / $1,543.03 / $3,955.04
| Facility | | $1,208.49 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.42 / $108.38 / $145.83
| Professional | | $78.42 | $108.38 | $145.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.68 / $134.82 / $203.80
| Professional | | $94.68 | $134.82 | $203.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.74 / $155.68 / $298.04
| Professional | | $97.74 | $155.68 | $298.04 |
- 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
- $119.80 / $185.51 / $270.25
| Professional | | $119.80 | $185.51 | $270.25 |