- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.84 / $537.92 / $842.10
| Facility | | $336.84 | $537.92 | $842.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,437.15 / $35,437.15 / $52,499.48
| Facility | | $35,437.15 | $35,437.15 | $52,499.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.26 / $326.26 / $326.26
| Professional | | $326.26 | $326.26 | $326.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.71 / $363.71 / $435.77
| Professional | | $363.71 | $363.71 | $435.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.30 / $219.30 / $219.30
| Professional | | $219.30 | $219.30 | $219.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.84 / $336.84 / $336.84
| Professional | | $336.84 | $336.84 | $336.84 |