- 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
- $44.73 / $108.76 / $194.43
| Professional | | $44.73 | $108.76 | $194.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.42 / $85.63 / $156.55
| Professional | | $47.42 | $85.63 | $156.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.68 / $141.82 / $195.14
| Professional | | $65.68 | $141.82 | $195.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.44 / $119.82 / $186.62
| Professional | | $61.44 | $119.82 | $186.62 |