- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,995.26 / $3,801.89
| Facility | | $758.58 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $831.76
| Professional | | $354.81 | $549.54 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $41,686.94 / $44,668.36
| Facility | | $41,686.94 | $41,686.94 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $19,498.45 / $19,498.45
| Facility | | $19,498.45 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $42.66 / $50.12
| Professional | | $38.02 | $42.66 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $19,054.61 / $41,686.94
| Facility | | $1,905.46 | $19,054.61 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $2,089.30
| Professional | | $758.58 | $1,023.29 | $2,089.30 |