- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.45 / $947.45 / $4,014.43
| Professional | | $947.45 | $947.45 | $4,014.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $17,120.82 / $43,765.58
| Facility | | $0.98 | $17,120.82 | $43,765.58 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.02 / $1.50 / $1.50
| Facility | 50 | $0.02 | $1.50 | $1.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.22 / $907.09 / $2,030.52
| Professional | | $323.22 | $907.09 | $2,030.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.86 / $2,144.01 / $5,157.71
| Facility | | $1,511.86 | $2,144.01 | $5,157.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.92 / $992.47 / $2,513.48
| Professional | | $375.92 | $992.47 | $2,513.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.44 / $1,960.14 / $4,061.19
| Facility | | $1,190.44 | $1,960.14 | $4,061.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.29 / $989.50 / $2,035.95
| Professional | | $354.29 | $989.50 | $2,035.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.52 / $1,045.11 / $10,743.00
| Facility | | $292.52 | $1,045.11 | $10,743.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,126.26 / $1,782.60 / $3,179.45
| Professional | | $1,126.26 | $1,782.60 | $3,179.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.40 / $1,538.85 / $3,035.86
| Professional | | $611.40 | $1,538.85 | $3,035.86 |