- 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
- $20.60 / $25.72 / $32.71
| Professional | | $20.60 | $25.72 | $32.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.66 / $33.96 / $45.75
| Professional | | $21.66 | $33.96 | $45.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.73 / $35.81 / $66.26
| Professional | | $26.73 | $35.81 | $66.26 |
- 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
- $30.06 / $47.84 / $74.97
| Professional | | $30.06 | $47.84 | $74.97 |