- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,467.37 / $9,772.37
| Facility | | $1,047.13 | $3,467.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,698.24 / $4,365.16
| Professional | | $549.54 | $1,698.24 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,467.37 / $7,079.46
| Facility | | $1,445.44 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.03
| Professional | | $0.02 | $0.02 | $0.03 |
- 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
- $741.31 / $3,981.07 / $7,943.28
| Professional | | $741.31 | $3,981.07 | $7,943.28 |
- 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
- $34.67 / $53.70 / $1,513.56
| Professional | | $34.67 | $53.70 | $1,513.56 |