- 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
- $16.12 / $20.20 / $27.89
| Professional | | $16.12 | $20.20 | $27.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.14 / $30.94 / $42.11
| Professional | | $22.14 | $30.94 | $42.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $41.60 / $61.59
| Professional | | $20.72 | $41.60 | $61.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.60 / $38.72 / $54.90
| Professional | | $24.60 | $38.72 | $54.90 |