- 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
- $12.66 / $25.05 / $28.91
| Professional | | $12.66 | $25.05 | $28.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.83 / $24.89 / $45.61
| Professional | | $14.83 | $24.89 | $45.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.31 / $29.91 / $67.06
| Professional | | $15.31 | $29.91 | $67.06 |
- 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
- $24.50 / $37.40 / $62.23
| Professional | | $24.50 | $37.40 | $62.23 |