- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,786.30 / $11,481.54
| Facility | | $794.33 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $794.33
| Professional | | $288.40 | $288.40 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $338.84
| Professional | | $0.02 | $0.03 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $489.78 / $1,148.15
| Facility | | $64.57 | $489.78 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,995.26 / $4,786.30
| Facility | | $676.08 | $1,995.26 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,862.09 / $3,630.78
| Professional | | $1,445.44 | $1,862.09 | $3,630.78 |