- 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
- $53.10 / $78.58 / $109.03
| Professional | | $53.10 | $78.58 | $109.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.22 / $83.61 / $132.75
| Professional | | $48.22 | $83.61 | $132.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.12 / $102.80 / $193.49
| Professional | | $57.12 | $102.80 | $193.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.00 / $1,183.00 / $4,915.00
| Facility | | $437.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.81 / $114.16 / $178.87
| Professional | | $72.81 | $114.16 | $178.87 |