- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $7,244.36
| Facility | | $3,235.94 | $3,235.94 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $213.80 / $426.58
| Professional | | $81.28 | $213.80 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $186.21 / $446.68
| Professional | | $74.13 | $186.21 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $416.87 / $1,318.26
| Facility | | $100.00 | $416.87 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $169.82 / $316.23
| Professional | | $72.44 | $169.82 | $316.23 |