- 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
- $98.74 / $225.39 / $413.16
| Professional | | $98.74 | $225.39 | $413.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.21 / $309.67 / $468.62
| Professional | | $155.21 | $309.67 | $468.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.49 / $291.92 / $725.53
| Professional | | $157.49 | $291.92 | $725.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.58 / $362.34 / $780.05
| Professional | | $262.58 | $362.34 | $780.05 |