- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,388.44 / $9,549.93
| Facility | | $1,096.48 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $524.81 / $5,370.32
| Professional | | $144.54 | $524.81 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,370.32 / $17,782.79
| Facility | | $1,288.25 | $5,370.32 | $17,782.79 |
- 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 / $2,511.89 / $15,848.93
| Facility | | $34.67 | $2,511.89 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $371.54 / $4,677.35
| Professional | | $162.18 | $371.54 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,471.29
| Facility | | $1,584.89 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $186.21 / $223.87
| Professional | | $39.81 | $186.21 | $223.87 |