- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.16 / $6,744.00 / $12,743.04
| Facility | | $1,140.16 | $6,744.00 | $12,743.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.17 / $3,071.19 / $7,751.70
| Professional | | $339.17 | $3,071.19 | $7,751.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $0.03 / $20.01
| Professional | | $0.03 | $0.03 | $20.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.50 / $1,326.50 / $1,326.50
| Professional | | $1,326.50 | $1,326.50 | $1,326.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,936.66 / $4,316.83 / $5,950.68
| Facility | | $3,936.66 | $4,316.83 | $5,950.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Professional | | $50.00 | $50.00 | $50.00 |