- 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
- $78.06 / $110.18 / $120.70
| Professional | | $78.06 | $110.18 | $120.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.06 / $124.78 / $193.65
| Professional | | $106.06 | $124.78 | $193.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.81 / $123.30 / $224.45
| Professional | | $80.81 | $123.30 | $224.45 |
- 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
- $74.61 / $123.14 / $181.74
| Professional | | $74.61 | $123.14 | $181.74 |