- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,235.94 / $9,120.11
| Facility | | $870.96 | $3,235.94 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $912.01 / $3,162.28
| Professional | | $186.21 | $912.01 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,890.45 / $13,489.63
| Facility | | $1,258.93 | $3,890.45 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $60.26
| Professional | | $0.02 | $0.02 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $10,000.00
| Facility | | $34.67 | $34.67 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $691.83 / $2,041.74
| Professional | | $213.80 | $691.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $151.36 / $162.18
| Professional | | $39.81 | $151.36 | $162.18 |