- 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
- $27.14 / $98.55 / $189.29
| Professional | | $27.14 | $98.55 | $189.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.03 / $99.08 / $186.91
| Professional | | $31.03 | $99.08 | $186.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.00 / $133.52 / $255.03
| Professional | | $44.00 | $133.52 | $255.03 |
- 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
- $107.05 / $180.28 / $306.48
| Professional | | $107.05 | $180.28 | $306.48 |