- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $851.14 / $1,862.09
| Facility | | $288.40 | $851.14 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $338.84
| Professional | | $257.04 | $257.04 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $19,498.45 / $34,673.69
| Facility | | $7,413.10 | $19,498.45 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Professional | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $812.83 / $1,862.09
| Facility | | $288.40 | $812.83 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $389.05
| Professional | | $257.04 | $257.04 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $21,379.62 / $26,302.68
| Facility | | $11,220.18 | $21,379.62 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Professional | | $977.24 | $977.24 | $977.24 |