- 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
- $69.86 / $106.22 / $252.13
| Professional | | $69.86 | $106.22 | $252.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.75 / $135.88 / $216.66
| Professional | | $80.75 | $135.88 | $216.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.50 / $143.18 / $371.16
| Professional | | $56.50 | $143.18 | $371.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,417.00 / $4,915.00
| Facility | | $540.00 | $1,417.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.10 / $227.60 / $270.07
| Professional | | $130.10 | $227.60 | $270.07 |