- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.07 / $1,262.00 / $3,225.53
| Facility | | $473.07 | $1,262.00 | $3,225.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.52 / $438.01 / $670.10
| Professional | | $339.52 | $438.01 | $670.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,858.56 / $29,858.56 / $35,830.26
| Facility | | $29,858.56 | $29,858.56 | $35,830.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.49 / $473.11 / $500.94
| Professional | | $378.49 | $473.11 | $500.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,797.62 / $20,797.62 / $20,797.62
| Facility | | $20,797.62 | $20,797.62 | $20,797.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.06 / $624.72 / $883.00
| Professional | | $372.06 | $624.72 | $883.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,654.00 / $10,126.00 / $20,724.00
| Facility | | $3,654.00 | $10,126.00 | $20,724.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.60 / $509.46 / $720.47
| Professional | | $325.60 | $509.46 | $720.47 |