- 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
- $31.76 / $45.00 / $56.80
| Professional | | $31.76 | $45.00 | $56.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.69 / $75.27 / $102.87
| Professional | | $52.69 | $75.27 | $102.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.09 / $80.19 / $148.40
| Professional | | $58.09 | $80.19 | $148.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.38 / $94.72 / $153.22
| Professional | | $57.38 | $94.72 | $153.22 |