- 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
- $36.32 / $76.40 / $128.27
| Professional | | $36.32 | $76.40 | $128.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.45 / $83.66 / $121.84
| Professional | | $42.45 | $83.66 | $121.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.61 / $94.77 / $159.81
| Professional | | $59.61 | $94.77 | $159.81 |
- 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
- $62.22 / $100.48 / $191.35
| Professional | | $62.22 | $100.48 | $191.35 |