- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,011.87 / $7,762.47
| Facility | | $1,380.38 | $5,011.87 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $323.59 / $5,888.44
| Professional | | $47.86 | $323.59 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $138.04 / $3,548.13
| Professional | | $67.61 | $138.04 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $8,709.64
| Professional | | $32.36 | $33.11 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $77.62 / $10,000.00
| Facility | | $54.95 | $77.62 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $3,388.44
| Professional | | $102.33 | $102.33 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,148.15 / $18,197.01
| Facility | | $229.09 | $1,148.15 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $131.83 / $3,548.13
| Professional | | $77.62 | $131.83 | $3,548.13 |