- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,495.41 / $12,022.64
| Facility | | $1,737.80 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $2,884.03 / $7,079.46
| Professional | | $346.74 | $2,884.03 | $7,079.46 |
- 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 / $12,302.69
| Professional | | $0.02 | $0.02 | $12,302.69 |
- 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
- $104.71 / $1,148.15 / $2,398.83
| Professional | | $104.71 | $1,148.15 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,949.84 / $4,677.35
| Facility | | $537.03 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $851.14 / $933.25
| Professional | | $39.81 | $851.14 | $933.25 |