- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,073.80 / $10,715.19
| Facility | | $1,230.27 | $4,073.80 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $1,288.25 / $3,981.07
| Professional | | $245.47 | $1,288.25 | $3,981.07 |
- 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 / $75.86
| Professional | | $0.02 | $0.02 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $323.59 / $38,904.51
| Facility | | $34.67 | $323.59 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $1,096.48 / $1,778.28
| Professional | | $269.15 | $1,096.48 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $154.88 / $2,884.03
| Professional | | $50.12 | $154.88 | $2,884.03 |