- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.46 / $689.02 / $21,135.70
| Facility | | $368.46 | $689.02 | $21,135.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.46 / $368.46 / $368.46
| Professional | | $368.46 | $368.46 | $368.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,298.12 / $20,728.33 / $32,546.70
| Facility | | $8,298.12 | $20,728.33 | $32,546.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.46 / $707.44 / $8,005.94
| Facility | | $368.46 | $707.44 | $8,005.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.46 / $368.46 / $379.59
| Professional | | $368.46 | $368.46 | $379.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,721.86 / $18,705.52 / $32,546.70
| Facility | | $7,721.86 | $18,705.52 | $32,546.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,544.84 / $19,975.18 / $25,976.31
| Facility | | $10,544.84 | $19,975.18 | $25,976.31 |