- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,353.34 / $3,202.26 / $4,803.39
| Facility | | $2,353.34 | $3,202.26 | $4,803.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.79 / $152.55 / $197.87
| Professional | | $117.79 | $152.55 | $197.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.66 / $195.88 / $294.10
| Professional | | $125.66 | $195.88 | $294.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,565.42 / $5,868.74 / $7,063.40
| Facility | | $2,565.42 | $5,868.74 | $7,063.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.20 / $245.07 / $425.72
| Professional | | $183.20 | $245.07 | $425.72 |