- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,862.09 / $30,902.95
| Facility | | $588.84 | $1,862.09 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $2,238.72 / $8,912.51
| Professional | | $33.11 | $2,238.72 | $8,912.51 |
- 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
- $269.15 / $269.15 / $269.15
| Facility | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $269.15 / $275.42
| Professional | | $229.09 | $269.15 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $79.43 / $269.15
| Professional | | $60.26 | $79.43 | $269.15 |