- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,370.32 / $12,022.64
| Facility | | $1,445.44 | $5,370.32 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $5,128.61 / $11,748.98
| Professional | | $831.76 | $5,128.61 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,128.61 / $15,135.61
| Facility | | $1,548.82 | $5,128.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.03
| Professional | | $0.02 | $0.02 | $0.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,000.00 / $17,782.79
| Facility | | $34.67 | $1,000.00 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $1,096.48 / $7,943.28
| Professional | | $97.72 | $1,096.48 | $7,943.28 |
- 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 / $630.96 / $676.08
| Professional | | $39.81 | $630.96 | $676.08 |