- 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
- $28.91 / $50.08 / $134.93
| Professional | | $28.91 | $50.08 | $134.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.77 / $85.86 / $139.81
| Professional | | $40.77 | $85.86 | $139.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.58 / $77.03 / $221.03
| Professional | | $39.58 | $77.03 | $221.03 |
- 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
- $85.10 / $128.56 / $219.16
| Professional | | $85.10 | $128.56 | $219.16 |