- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,819.70 / $3,467.37
| Facility | | $630.96 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $389.05 / $630.96
| Professional | | $338.84 | $389.05 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $31,622.78
| Facility | | $23,442.29 | $23,442.29 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $478.63
| Professional | | $354.81 | $354.81 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $33,113.11
| Facility | | $8,709.64 | $8,709.64 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $616.60 / $831.76
| Professional | | $416.87 | $616.60 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $14,454.40 / $38,018.94
| Facility | | $3,715.35 | $14,454.40 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $794.33
| Professional | | $331.13 | $549.54 | $794.33 |