- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $346.74 / $645.65
| Facility | | $288.40 | $346.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $346.74 / $537.03
| Professional | | $288.40 | $346.74 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $18,197.01 / $23,988.33
| Facility | | $676.08 | $18,197.01 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $676.08 / $1,148.15
| Professional | | $457.09 | $676.08 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $50,118.72 / $53,703.18
| Facility | | $50,118.72 | $50,118.72 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $426.58
| Professional | | $331.13 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $630.96 / $851.14
| Professional | | $275.42 | $630.96 | $851.14 |