- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,370.32 / $11,748.98
| Facility | | $1,737.80 | $5,370.32 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $4,897.79 / $11,748.98
| Professional | | $831.76 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $134.90 / $151.36
| Facility | | $114.82 | $134.90 | $151.36 |
- 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 / $50,118.72
| Facility | | $64.57 | $64.57 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $93.33 / $162.18
| Facility | | $47.86 | $93.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $93.33 / $190.55
| Professional | | $39.81 | $93.33 | $190.55 |