- 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
- $57.74 / $84.42 / $134.26
| Professional | | $57.74 | $84.42 | $134.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.78 / $79.98 / $165.98
| Professional | | $57.78 | $79.98 | $165.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.77 / $129.46 / $240.26
| Professional | | $80.77 | $129.46 | $240.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.41 / $106.18 / $210.90
| Professional | | $56.41 | $106.18 | $210.90 |