- 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
- $85.37 / $88.31 / $123.42
| Professional | | $85.37 | $88.31 | $123.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.82 / $113.90 / $195.83
| Professional | | $96.82 | $113.90 | $195.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.06 / $156.74 / $227.65
| Professional | | $73.06 | $156.74 | $227.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.67 / $137.94 / $213.06
| Professional | | $94.67 | $137.94 | $213.06 |