- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.47 / $9,338.46 / $20,400.00
| Facility | | $530.47 | $9,338.46 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.39 / $547.78 / $616.74
| Professional | | $383.39 | $547.78 | $616.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.70 / $513.29 / $758.31
| Facility | | $352.70 | $513.29 | $758.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.18 / $461.63 / $488.63
| Facility | | $338.18 | $461.63 | $488.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.70 / $587.77 / $5,626.00
| Facility | | $352.70 | $587.77 | $5,626.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,277.96 / $10,794.36 / $14,018.87
| Facility | | $8,277.96 | $10,794.36 | $14,018.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $9,074.00 / $12,786.00
| Facility | | $1,981.00 | $9,074.00 | $12,786.00 |