- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,318.26 / $7,762.47
| Facility | | $575.44 | $1,318.26 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $3,162.28 / $8,912.51
| Professional | | $524.81 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $69.18 / $295.12
| Facility | | $57.54 | $69.18 | $295.12 |
- 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
- $151.36 / $151.36 / $426.58
| Facility | | $151.36 | $151.36 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $218.78 / $1,096.48
| Professional | | $53.70 | $218.78 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $42.66 / $57.54
| Professional | | $38.90 | $42.66 | $57.54 |