- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,612.00 / $6,680.00 / $11,332.00
| Facility | | $2,612.00 | $6,680.00 | $11,332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.28 / $503.10 / $616.89
| Professional | | $437.28 | $503.10 | $616.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.66 / $654.66 / $654.66
| Professional | | $654.66 | $654.66 | $654.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,210.64 / $25,443.31 / $55,173.54
| Facility | | $21,210.64 | $25,443.31 | $55,173.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.49 / $560.03 / $889.93
| Professional | | $431.49 | $560.03 | $889.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,718.00 / $19,661.00 / $38,981.00
| Facility | | $8,718.00 | $19,661.00 | $38,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.42 / $602.83 / $1,534.48
| Professional | | $451.42 | $602.83 | $1,534.48 |