- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $28,183.83
| Facility | | $1,380.38 | $4,897.79 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,412.54 / $6,456.54
| Professional | | $354.81 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,025.60 / $16,595.87
| Facility | | $3,090.30 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,071.52 / $1,096.48
| Facility | | $870.96 | $1,071.52 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $616.60 / $4,786.30
| Professional | | $602.56 | $616.60 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $2,137.96 / $5,754.40
| Facility | | $199.53 | $2,137.96 | $5,754.40 |