- 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
- $57.40 / $70.83 / $94.58
| Professional | | $57.40 | $70.83 | $94.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.51 / $86.44 / $115.79
| Professional | | $60.51 | $86.44 | $115.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.45 / $107.68 / $144.29
| Professional | | $58.45 | $107.68 | $144.29 |
- 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
- $62.62 / $98.25 / $150.22
| Professional | | $62.62 | $98.25 | $150.22 |