- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,132.88 / $3,955.04
| Facility | | $2,090.73 | $3,132.88 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.32 / $31.61 / $67.23
| Professional | | $24.32 | $31.61 | $67.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.51 / $33.72 / $68.20
| Professional | | $25.51 | $33.72 | $68.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.31 / $52.09 / $68.34
| Professional | | $33.31 | $52.09 | $68.34 |
- 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
- $28.97 / $46.61 / $79.91
| Professional | | $28.97 | $46.61 | $79.91 |