- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,454.71 / $7,943.28
| Facility | | $501.19 | $2,454.71 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $645.65 / $6,760.83
| Professional | | $112.20 | $645.65 | $6,760.83 |
- 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 / $316.23
| Professional | | $0.02 | $0.02 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $2,511.89
| Facility | | $34.67 | $398.11 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $977.24 / $1,445.44
| Professional | | $89.13 | $977.24 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,071.52 / $3,467.37
| Facility | | $234.42 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $63.10 / $416.87
| Professional | | $39.81 | $63.10 | $416.87 |