- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.13 / $1,518.41 / $3,955.04
| Facility | | $1,305.13 | $1,518.41 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.54 / $52.39 / $64.33
| Professional | | $38.54 | $52.39 | $64.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.58 / $62.40 / $83.81
| Professional | | $49.58 | $62.40 | $83.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.08 / $96.51 / $140.36
| Professional | | $46.08 | $96.51 | $140.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.40 / $84.71 / $125.79
| Professional | | $58.40 | $84.71 | $125.79 |