- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,698.24 / $1,778.28
| Facility | | $794.33 | $1,698.24 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Professional | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64,565.42 / $83,176.38 / $95,499.26
| Facility | | $64,565.42 | $83,176.38 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $457.09
| Facility | | $323.59 | $446.68 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $446.68 / $457.09
| Professional | | $323.59 | $446.68 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $79.43 / $85.11
| Professional | | $60.26 | $79.43 | $85.11 |