- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,370.32 / $11,748.98
| Facility | | $1,698.24 | $5,370.32 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $3,890.45 / $11,748.98
| Professional | | $831.76 | $3,890.45 | $11,748.98 |
- 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 / $60.26
| Professional | | $0.02 | $0.02 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $512.86 / $2,344.23
| Facility | | $34.67 | $512.86 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $398.11 / $1,258.93
| Professional | | $100.00 | $398.11 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,467.37
| Facility | | $229.09 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $60.26 / $1,778.28
| Professional | | $39.81 | $60.26 | $1,778.28 |