- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $9,120.11 / $16,595.87
| Facility | | $794.33 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $645.65 / $977.24
| Professional | | $562.34 | $645.65 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $891.25
| Professional | | $478.63 | $676.08 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $54,954.09 / $54,954.09
| Facility | | $28,840.32 | $54,954.09 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $1,288.25
| Professional | | $562.34 | $812.83 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $1,548.82
| Facility | | $562.34 | $812.83 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,760.83 / $9,120.11
| Facility | | $2,454.71 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $1,412.54
| Professional | | $562.34 | $776.25 | $1,412.54 |