- 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
- $32.31 / $45.67 / $77.20
| Professional | | $32.31 | $45.67 | $77.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $52.52 / $91.10
| Professional | | $34.67 | $52.52 | $91.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.59 / $71.29 / $97.98
| Professional | | $48.59 | $71.29 | $97.98 |
- 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
- $43.72 / $68.59 / $106.33
| Professional | | $43.72 | $68.59 | $106.33 |