- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,818.38 / $8,511.38
| Facility | | $851.14 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $8,511.38
| Professional | | $676.08 | $676.08 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $10,715.19 / $11,220.18
| Facility | | $5,128.61 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Professional | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60,255.96 / $81,283.05 / $107,151.93
| Facility | | $60,255.96 | $81,283.05 | $107,151.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60,255.96 / $72,443.60 / $87,096.36
| Professional | | $60,255.96 | $72,443.60 | $87,096.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Facility | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $44.67 / $67.61
| Professional | | $35.48 | $44.67 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $794.33 / $3,388.44
| Facility | | $331.13 | $794.33 | $3,388.44 |