- 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
- $52.40 / $88.27 / $110.90
| Professional | | $52.40 | $88.27 | $110.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.45 / $60.53 / $177.60
| Professional | | $51.45 | $60.53 | $177.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.21 / $77.38 / $120.09
| Professional | | $39.21 | $77.38 | $120.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,417.00 / $4,915.00
| Facility | | $540.00 | $1,417.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.50 / $81.26 / $151.31
| Professional | | $43.50 | $81.26 | $151.31 |