- 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
- $100.40 / $130.24 / $147.69
| Professional | | $100.40 | $130.24 | $147.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.86 / $158.66 / $229.29
| Professional | | $134.86 | $158.66 | $229.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.35 / $151.61 / $286.41
| Professional | | $93.35 | $151.61 | $286.41 |
- 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
- $85.89 / $133.53 / $199.78
| Professional | | $85.89 | $133.53 | $199.78 |