- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,355.53 / $1,543.03 / $3,955.04
| Facility | | $1,355.53 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.82 / $49.16 / $84.95
| Professional | | $39.82 | $49.16 | $84.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.11 / $61.58 / $81.80
| Professional | | $43.11 | $61.58 | $81.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.72 / $75.51 / $104.52
| Professional | | $45.72 | $75.51 | $104.52 |
- 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
- $52.69 / $72.44 / $102.38
| Professional | | $52.69 | $72.44 | $102.38 |