- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.51 / $9,116.28 / $81,705.17
| Facility | | $344.51 | $9,116.28 | $81,705.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.06 / $343.48 / $400.10
| Professional | | $332.06 | $343.48 | $400.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,834.80 / $28,834.80 / $28,834.80
| Facility | | $28,834.80 | $28,834.80 | $28,834.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.50 / $462.03 / $678.62
| Professional | | $305.50 | $462.03 | $678.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,131.99 / $6,131.99 / $6,131.99
| Facility | | $6,131.99 | $6,131.99 | $6,131.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,842.00 / $15,842.00 / $15,842.00
| Facility | | $15,842.00 | $15,842.00 | $15,842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.91 / $490.00 / $820.58
| Professional | | $309.91 | $490.00 | $820.58 |