- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.33 / $4,933.00 / $6,853.00
| Facility | | $384.33 | $4,933.00 | $6,853.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.75 / $367.52 / $384.33
| Professional | | $242.75 | $367.52 | $384.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,987.19 / $20,987.19 / $20,987.19
| Facility | | $20,987.19 | $20,987.19 | $20,987.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,937.83 / $21,826.68 / $28,332.71
| Professional | | $19,937.83 | $21,826.68 | $28,332.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.58 / $4,933.00 / $6,853.00
| Facility | | $418.58 | $4,933.00 | $6,853.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.33 / $418.58 / $548.88
| Professional | | $384.33 | $418.58 | $548.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,555.00 / $18,687.00 / $25,752.00
| Facility | | $10,555.00 | $18,687.00 | $25,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.58 / $532.47 / $743.50
| Professional | | $452.58 | $532.47 | $743.50 |