- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,370.32 / $11,748.98
| Facility | | $1,737.80 | $5,370.32 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,754.23 / $10,715.19
| Professional | | $1,047.13 | $2,754.23 | $10,715.19 |
- 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 / $60.26
| Professional | | $0.02 | $0.02 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $467.74 / $1,000.00
| Facility | | $34.67 | $467.74 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $114.82 / $1,096.48
| Professional | | $100.00 | $114.82 | $1,096.48 |
- 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 / $323.59 / $380.19
| Professional | | $39.81 | $323.59 | $380.19 |