- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,248.07 / $12,589.25
| Facility | | $1,737.80 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,344.23 / $5,754.40
| Professional | | $1,096.48 | $2,344.23 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,248.07 / $15,135.61
| Facility | | $1,548.82 | $5,248.07 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $52.48
| Professional | | $0.02 | $0.02 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $616.60 / $13,182.57
| Facility | | $34.67 | $616.60 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,348.96 / $1,905.46
| Professional | | $1,230.27 | $1,348.96 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,606.93 / $15,848.93
| Facility | | $1,778.28 | $6,606.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $48.98 / $4,168.69
| Professional | | $44.67 | $48.98 | $4,168.69 |