- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,370.32 / $12,022.64
| Facility | | $1,621.81 | $5,370.32 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $1,819.70 / $4,677.35
| Professional | | $263.03 | $1,819.70 | $4,677.35 |
- 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 / $47.86
| Professional | | $0.02 | $0.02 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $38,904.51
| Facility | | $34.67 | $398.11 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $537.03 / $1,122.02
| Professional | | $416.87 | $537.03 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,905.46 / $4,677.35
| Facility | | $537.03 | $1,905.46 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $27.54 / $54.95
| Professional | | $25.70 | $27.54 | $54.95 |