- 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
- $38.76 / $53.22 / $56.01
| Professional | | $38.76 | $53.22 | $56.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.26 / $62.66 / $99.35
| Professional | | $53.26 | $62.66 | $99.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.08 / $85.57 / $113.52
| Professional | | $44.08 | $85.57 | $113.52 |
- 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
- $56.53 / $78.69 / $114.94
| Professional | | $56.53 | $78.69 | $114.94 |