- 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
- $19.82 / $43.36 / $56.04
| Professional | | $19.82 | $43.36 | $56.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.50 / $38.03 / $73.75
| Professional | | $22.50 | $38.03 | $73.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.92 / $49.16 / $108.42
| Professional | | $22.92 | $49.16 | $108.42 |
- 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
- $43.60 / $68.06 / $100.36
| Professional | | $43.60 | $68.06 | $100.36 |