- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,548.13 / $9,772.37
| Facility | | $1,071.52 | $3,548.13 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $1,862.09 / $8,912.51
| Professional | | $263.03 | $1,862.09 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,467.37 / $7,079.46
| Facility | | $1,412.54 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $8,128.31
| Professional | | $0.02 | $0.03 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $1,000.00
| Facility | | $34.67 | $398.11 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,258.93 / $2,454.71
| Professional | | $549.54 | $1,258.93 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $89.13 / $281.84
| Professional | | $39.81 | $89.13 | $281.84 |