- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $9,549.93 / $17,378.01
| Facility | | $512.86 | $9,549.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $794.33
| Professional | | $512.86 | $512.86 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $1,905.46 / $2,290.87
| Professional | | $275.42 | $1,905.46 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $588.84 / $7,943.28
| Facility | | $512.86 | $588.84 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $3,162.28
| Professional | | $512.86 | $512.86 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $562.34 / $870.96
| Facility | | $512.86 | $562.34 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $79.43 / $79.43
| Professional | | $70.79 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $16,218.10 / $23,988.33
| Facility | | $2,884.03 | $16,218.10 | $23,988.33 |