- 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
- $360.87 / $431.73 / $506.33
| Professional | | $360.87 | $431.73 | $506.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $945.31 / $945.31
| Professional | | $0.02 | $945.31 | $945.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.37 / $560.55 / $1,016.77
| Professional | | $465.37 | $560.55 | $1,016.77 |
- 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
- $282.98 / $446.05 / $755.00
| Professional | | $282.98 | $446.05 | $755.00 |