- 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
- $79.28 / $108.72 / $138.65
| Professional | | $79.28 | $108.72 | $138.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.18 / $121.74 / $181.04
| Professional | | $94.18 | $121.74 | $181.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.68 / $140.19 / $234.11
| Professional | | $112.68 | $140.19 | $234.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.18 / $154.22 / $263.04
| Professional | | $100.18 | $154.22 | $263.04 |