- 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
- $33.31 / $53.69 / $73.64
| Professional | | $33.31 | $53.69 | $73.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.09 / $70.18 / $114.29
| Professional | | $38.09 | $70.18 | $114.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.77 / $87.67 / $162.57
| Professional | | $47.77 | $87.67 | $162.57 |
- 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
- $69.33 / $98.89 / $174.15
| Professional | | $69.33 | $98.89 | $174.15 |