- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.61 / $5,282.00 / $11,024.00
| Facility | | $491.61 | $5,282.00 | $11,024.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,160.00 / $18,351.00 / $19,756.00
| Facility | | $14,160.00 | $18,351.00 | $19,756.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $734.64
| Facility | | $640.00 | $640.00 | $734.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.22 / $2,161.46 / $2,554.44
| Professional | | $1,670.22 | $2,161.46 | $2,554.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.61 / $1,647.52 / $3,109.05
| Facility | | $491.61 | $1,647.52 | $3,109.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.83 / $598.16 / $2,517.09
| Facility | | $434.83 | $598.16 | $2,517.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $8,621.00 / $17,321.00
| Facility | | $5,121.00 | $8,621.00 | $17,321.00 |