- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.65 / $3,243.94 / $3,955.04
| Facility | | $2,376.65 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.00 / $656.25 / $656.25
| Professional | | $49.00 | $656.25 | $656.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $1,400.30 / $1,400.30
| Professional | | $0.02 | $1,400.30 | $1,400.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.20 / $205.20 / $667.55
| Professional | | $205.20 | $205.20 | $667.55 |