- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $12,882.50
| Facility | | $1,698.24 | $5,248.07 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,659.59 / $7,585.78
| Professional | | $575.44 | $1,659.59 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $8,317.64 / $21,379.62
| Facility | | $2,818.38 | $8,317.64 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $10,000.00 / $22,908.68
| Facility | | $34.67 | $10,000.00 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $1,202.26 / $1,380.38
| Professional | | $281.84 | $1,202.26 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $50.12 / $60.26
| Professional | | $34.67 | $50.12 | $60.26 |