- 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 / $20.52 / $28.72
| Professional | | $12.66 | $20.52 | $28.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.65 / $24.37 / $35.42
| Professional | | $14.65 | $24.37 | $35.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.52 / $26.92 / $49.83
| Professional | | $18.52 | $26.92 | $49.83 |
- 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
- $21.66 / $33.61 / $51.43
| Professional | | $21.66 | $33.61 | $51.43 |