- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $6,309.57 / $26,915.35
| Facility | | $1,148.15 | $6,309.57 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $3,235.94
| Professional | | $912.01 | $912.01 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,657.95 / $46,773.51 / $52,480.75
| Facility | | $42,657.95 | $46,773.51 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $3.39 / $3.98
| Professional | | $0.02 | $3.39 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $16,218.10 / $46,773.51
| Facility | | $8,511.38 | $16,218.10 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $2,089.30
| Facility | | $912.01 | $1,148.15 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $20,892.96 / $40,738.03
| Facility | | $10,964.78 | $20,892.96 | $40,738.03 |