- 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
- $75.65 / $83.64 / $98.63
| Professional | | $75.65 | $83.64 | $98.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.31 / $92.14 / $145.63
| Professional | | $78.31 | $92.14 | $145.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.98 / $106.59 / $154.85
| Professional | | $88.98 | $106.59 | $154.85 |
- 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
- $58.85 / $106.04 / $163.25
| Professional | | $58.85 | $106.04 | $163.25 |