- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $676.08 / $676.08
| Facility | | $263.03 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64,565.42 / $64,565.42 / $64,565.42
| Professional | | $64,565.42 | $64,565.42 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $630.96 / $1,148.15
| Facility | | $263.03 | $630.96 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $676.08 / $676.08
| Facility | | $263.03 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $676.08 / $831.76
| Facility | | $354.81 | $676.08 | $831.76 |