- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.66 / $644.51 / $724.48
| Professional | | $280.66 | $644.51 | $724.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $324.70 / $368.00
| Professional | | $0.02 | $324.70 | $368.00 |
- 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
- $429.82 / $796.03 / $1,244.06
| Professional | | $429.82 | $796.03 | $1,244.06 |