- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,862.09 / $30,902.95
| Facility | | $1,380.38 | $1,862.09 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $2,137.96
| Professional | | $1,621.81 | $1,621.81 | $2,137.96 |
- 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
- $64.57 / $64.57 / $53,703.18
| Facility | | $64.57 | $64.57 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,548.82 / $6,309.57
| Facility | | $1,148.15 | $1,548.82 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |