- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.54 / $2,778.87 / $3,955.04
| Facility | | $1,388.54 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.54 / $201.56 / $385.70
| Professional | | $100.54 | $201.56 | $385.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.87 / $220.30 / $346.97
| Professional | | $95.87 | $220.30 | $346.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.65 / $269.98 / $470.45
| Professional | | $139.65 | $269.98 | $470.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.00 / $3,465.00 / $5,510.00
| Facility | | $1,806.00 | $3,465.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.07 / $362.01 / $561.20
| Professional | | $200.07 | $362.01 | $561.20 |