- 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
- $54.08 / $115.45 / $156.19
| Professional | | $54.08 | $115.45 | $156.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.42 / $134.18 / $235.06
| Professional | | $82.42 | $134.18 | $235.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.64 / $140.94 / $291.42
| Professional | | $88.64 | $140.94 | $291.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.82 / $201.99 / $313.39
| Professional | | $106.82 | $201.99 | $313.39 |