- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,774.33 / $3,955.04
| Facility | | $3,706.14 | $3,774.33 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.32 / $39.77 / $48.32
| Professional | | $27.32 | $39.77 | $48.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.57 / $49.45 / $68.18
| Professional | | $40.57 | $49.45 | $68.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.31 / $45.82 / $86.46
| Professional | | $28.31 | $45.82 | $86.46 |
- 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
- $37.90 / $47.91 / $64.55
| Professional | | $37.90 | $47.91 | $64.55 |